An overview of health policies for asylum-seekers in Germany. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Gottlieb, Nora; Schülle, Mirjam
• Is Part Of: Health policy. Volume 125:Issue 1(2021)
• Page Start: 115
• Page End: 121
• Publication Date: 2021-01
• Subjects: Access to healthcare -- Asylum-seekers -- Germany -- Health inequities -- Health policy -- Health rights -- Migrant health; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.09.009
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: This detailed description of Germany's asylum-seeker health policies facilitates comparative research. Asylum-seekers' restricted health entitlements are regulated and administered through a parallel system. Parallel systems can lead to fragmentation, complexity and differential health care access. Decentralization allows tailoring service provision to local conditions; but it can amplify inequities. Asylum-seekers' integration in statutory health insurance could reduce fragmentation and mitigate inequities. Abstract: Health policies for asylum-seekers are a subject of debate across European countries. However, information on current strategies to respond to these populations' health needs is scarce. To facilitate comparative research, this paper renders a detailed overview of Germany's asylum-seeker health policies. Following a description of the historic development and administrative structure of asylum-seeker health care in Germany, we provide a detailed account of asylum-seekers' scope of health entitlements, as it is defined by federal law. We explain the main mechanisms that are used to implement the law on local levels and regulate health care access; namely, the electronic health insurance card and the health care voucher. Financing and billing structures are described, and main points of critique of Germany's asylum-seeker health policies are summarized. Our description highlights fragmentation and internal variations as central features of Germany's asylum-seeker health policies. It explicates how these features are rooted in decentralization, and in the regulation of restricted health benefits through a parallel system, separate from statutory health insurance. As a case-study, Germany's asylum-seeker health policies illustrate the administrative, economic and ethical burdens implied in granting health benefits through a parallel system, and in absence of central health governance. The (re)integration of asylum-seeker health care in statutory health insurance could reduce these burdens and contribute to equitable health care access.