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[Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?]

ABSTRACT: PURPOSE:In the area of the Asylum Seeker Benefits Act (AsylbLG), there are two options for granting benefits that have practical relevance to health care (depending on the period of previous residence): minimum provision and benefits in special cases, analogous to the Social Code Book XII (SGB XII). METHOD:This secondary data analysis examines the performance of benefits in the case of illness among benefit recipients according to the AsylbLG at the Research Data Centre of the Federal and State Statistical Offices. The examined group of individuals have not yet been granted refugee status or asylum entitlement. RESULTS:As of 31 December 2018, 423,201 persons in Germany were receiving benefits according to the AsylbLG. A good third of these were women. The average age was 24 years, and more than half came from Asia. More than one-third of all benefit recipients were in outpatient (33.5%) or inpatient treatment (1.3%). Among the federal states, benefits for assistance in the case of illness as well as the health-related per capita gross expenditure varied considerably. The provision of illness benefits in reception facilities was relatively low. With the health card, the use of inpatient treatment was higher. The standard health-related provision of assistance in special cases (§2 AsylbLG analogous to SGB XII) reached a higher share of people entitled to benefits at the end of the year (42.7%) than the minimum provision according to §3 AsylbLG (29.0%). Nevertheless, it caused comparatively less gross expenditure. CONCLUSION:It is recommended to apply §2 AsylbLG for a prestay period of three months or longer in order to be able to grant assistance analogous to Chapters 5 to 9 SGB XII earlier. Nationwide introduction of an electronic health insurance card for asylum seekers would improve access.

SUBMITTER: Hollederer A

PROVIDER: S-EPMC7508245 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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[Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?]

Hollederer Alfons A

Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 20200922 10

<h4>Purpose</h4>In the area of the Asylum Seeker Benefits Act (AsylbLG), there are two options for granting benefits that have practical relevance to health care (depending on the period of previous residence): minimum provision and benefits in special cases, analogous to the Social Code Book XII (SGB XII).<h4>Method</h4>This secondary data analysis examines the performance of benefits in the case of illness among benefit recipients according to the AsylbLG at the Research Data Centre of the Fed ...[more]

PMID: 32964252

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Project description:BACKGROUND:Migrant health has become an essential part of public health. According to the World Health Organization, many health systems in Europe have not yet adapted adequately to the needs of asylum-seekers, which might result in untimely and inefficient health care for asylum-seeking patients. The aim of this study was to assess the number of preventable hospital admissions and emergency department visits in asylum-seeking and non-asylum-seeking pediatric patients. METHODS:This is a retrospective, hospital-based study. The study was done at the University Children's Hospital Basel in Switzerland. Patients admitted or presenting to the emergency department were included and split into the groups of asylum-seeking and non-asylum-seeking patients. All admissions and emergency-department visits were extracted from the administrative electronic health records from 1st Jan 2016-31st Dec 2017. The main outcome was the proportion of admissions due to ambulatory-care-sensitive conditions (which refer to conditions for which admission can be prevented by early interventions in primary care) in asylum-seeking and non-asylum-seeking patients. Ambulatory-care-sensitive conditions were defined by a validated list of ICD-10 codes. The secondary objective was to assess the number of preventable emergency-department visits by asylum-seeking patients defined as proportion of visits with a non-urgent triage score. RESULTS:A total of 75'199 hospital visits were included, of which 63'405 were emergency department visits and 11'794 were admissions. Ambulatory-care-sensitive conditions accounted for 12.1% (18/149) of asylum-seeking and 10.9% (1270/11645) of non-asylum seeking patients' admissions. Among the emergency department visits by asylum-seeking patients, non-urgent conditions accounted for 82.2% (244/297). CONCLUSIONS:Admissions due to ambulatory-care-sensitive conditions are comparable in asylum-seeking and non-asylum-seeking children, suggesting few delayed presentations to ambulatory care facilities. Strategies to prevent non-urgent visits at pediatric emergency department facilities are needed.

Project description:BACKGROUND:Research has shown that discrimination is harmful to health, but there is relatively little known about discrimination experienced by people from refugee and asylum-seeking backgrounds in resettlement countries and associated health effects. This qualitative-focused mixed methods paper reports on discrimination experienced by refugees and asylum seekers, responses to discrimination, and impacts on health. METHODS:As part of a broader study of housing, social inclusion and health, surveys were completed by 423 adult refugees and asylum seekers living in South Australia who had been in Australia for up to 7?years. The survey included questions on discrimination based on skin colour, ethnicity and religion, as well as questions on hope, trust, belonging, sense of control and health (including the SF-8). Semi-structured interviews were conducted with 65 survey participants, purposively sampled by visa status, continent and gender, further exploring experiences of discrimination. These and survey open-ended responses were analysed thematically. RESULTS:Twenty-two percent of survey participants reported experiences of discrimination since arriving in Australia (14% in the last year), and 90% of these felt that discrimination had harmed their health. Key settings of discrimination were public transport, within the neighbourhood, and in relation to employment. Those who reported discrimination had significantly worse mental health (p <?.000) but not physical health. Discrimination was also associated with less sense of belonging (p =?.001), lower levels of trust (p =?.038), reduced sense of control (p =?.012) and less hope (p =?.006). Incidents described in interviews and the open-ended survey responses included incivility, physical assault, and denial of services, experienced across intersecting characteristics of race/ethnicity, religion, gender and visa status. Responses to discrimination spanned affective, cognitive and behavioural dimensions, ranging across types of experience, participant characteristics and context, with most individuals reporting multiple response types. While some of the responses were reported by participants as protective of health, participants' reflections indicated significant negative impacts on mental health in particular. CONCLUSION:Discrimination featured in the resettlement experiences of a significant number of refugees and asylum seekers, with participants reporting clear negative impacts on mental health. Addressing discrimination is a key resettlement and health issue requiring urgent action.

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Project description:BackgroundFor the general population, the positive effects of paid employment on health and wellbeing are well established. However, less is known for people from refugee and asylum-seeking backgrounds. This review aims to systematically summarise the quantitative literature on the relationship between employment and health and wellbeing for refugees and asylum seekers.MethodA search strategy was conducted in online databases, including MEDLINE, PsychINFO, EMCARE, SCOPUS, CINHAL, ProQuest and Web of Science. Articles were screened against inclusion and exclusion criteria. Studies published in English between 2000 to October 2021 were included if they used quantitative methods to consider the relationship between employment and health for refugees and asylum seekers in resettlement countries. Study quality was assessed using The Joanna Briggs Institute's Critical Appraisal Tools. Findings were synthesised using a narrative approach.ResultsSeventy-two papers were identified. The majority of papers (N = 58, 81%) examined the association between employment and mental health outcomes. Overall, while there were inconsistencies in the findings, employment had a positive effect on mental health particularly in reducing levels of psychological distress and depression. Though more limited in number, the papers examining physical health suggest that people who are employed tend to have better physical health than unemployed persons. There was some evidence to support the bi-directional relationship between employment and health. Poor mental and physical health negatively impacted the odds of employment and occupational status of refugees.ConclusionGood quality employment is an essential component of refugee resettlement and this review found that in general employment is also beneficial for refugee health, particularly aspects of mental health. More research regarding the effects of employment on physical health is required. The effects of refugee-specific factors such as gender roles, torture, and trauma on the relationship between employment and health also require further investigation.

Dataset Information

[Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?]

Publications

[Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?]

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