Abstract
BackgroundResearch on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. We aimed to analyse the principles of horizontal equity (i.e., equal access for equal need irrespective of socioeconomic status, SES) and vertical equity (higher allocation of resources to those with higher need) among asylum-seekers in Germany.MethodsWe performed a secondary exploratory analysis on cross-sectional data obtained from a population-based questionnaire survey among all asylum-seekers (aged 18 or above) registered in three administrative districts in Germany during the three-month study period (N = 1017). Data were collected on health care access (health care utilisation of four types of services and unmet medical need), health care need (approximated by sex, age and self-rated health status), and SES (highest educational attainment and subjective social status, SSS). We calculated odds ratios and 95 % confidence intervals (CI) in multiple logistic regression models to analyse associations between SES indicators and access to health care under control of need.ResultsWe contacted 60.4 % (614) of the total asylum-seekers population, of which 25.4 % (N = 156) participated in the study. Educational attainment showed no significant effect on health care access in crude models, but was positively associated with utilisation of psychotherapists and hospital admissions in adjusted models. Higher SSS was positively associated with health care utilisation of all types of services. The odds of hospitals admissions for asylum-seekers in the medium and highest SSS category were 3.18 times [1.06, 9.59] and 1.6 times [0.49, 5.23] the odds of those in the lowest SSS category. After controlling for need variables none of the SES indicators were significantly associated with measures of access to care, but a positive association remained, indicating higher utilisation of health care among asylum-seekers with higher SES. Age, sex or general health status were the only significant predictors of health care utilisation in fully adjusted models. The adjusted odds of reporting unmet medical needs among asylum-seekers with “fair/bad/very bad” health status were 2.16 times [0.84, 5.59] the odds of those with “good/very good” health status.ConclusionOur findings revealed that utilisation of health services among asylum-seekers is associated with higher need (vertical equity met). Horizontal equity was met with respect to educational attainment for most outcomes, but a social gradient in health care utilisation was observed across SSS. Further confirmatory research is needed, especially on potential inequities in unmet medical need and on measurements of SES among asylum-seekers.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1156-x) contains supplementary material, which is available to authorized users.
Highlights
Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers
Descriptive results Of 1017 asylum-seekers registered in the three administrative districts during the study period, 614 (60.4 %) could be contacted and 156 asylum-seekers from 22 countries participated in the study, yielding a response rate of 25.4 %
The gender ratio of our sample (2.9 : 1) does not reflect the gender distribution of asylum-seekers in the Federal State (2.0 : 1). This means that asylum-seeking women were underrepresented in our survey, which may have affected our results in terms of health care access for this group. This first study of equity in health care access among asylum-seekers in Germany found trends towards horizontal inequities based on social status (SSS) for all outcome measures, and on educational attainment for utilisation of psychotherapists and hospitalisations
Summary
Research on inequities in access to health care among asylum-seekers has focused on disparities between asylum-seekers and resident populations, but little attention has been paid to potential inequities in access to care within the group of asylum-seekers. Unprecedented levels of forced migrants seeking asylum in other countries [1] challenge the provision of highquality care in line with the values of European health systems such as equity in access to health care [2]. Access to health care is initially restricted for asylumseekers in many European countries, despite the principles of universality and equity [4]. The country receiving the highest absolute number of asylum applications worldwide [1], has set up legal restrictions on access to health care for asylum-seekers. These have been in place since the 1990s. Entitlements to medical care are detailed in the Asylum-Seekers’ Benefits Act (AsylbLG), a national law which restricts access to health care. Services covered include emergency care, care for acute and painful conditions, care during pregnancy and child birth, vaccinations and other “indicated preventive measures” (AsylbLG sections 4 and 6) [5]
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