Abstract
BackgroundAsylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations.MethodsUsing claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision.ResultsThe estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector.ConclusionThe analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.
Highlights
Health care utilization is structured by health care needs on one hand and the availability of accessible, acceptable high quality health care services on the other [1]
Even though these special needs of asylum seekers are well established in the literature and the German health care system is able to provide acceptable, high quality care, with the Asylum Seekers’ Benefits Act (“Asylbewerberleistungsgesetz”, Asylum seekers benefits act (ASBA)) German law creates barriers in access to health care [17]
The ASBA excludes this group from the statutory health insurance, appoints the municipal authorities with carrying health care costs and restricts entitlement to treatment to certain health care needs, namely, acute and painful conditions, as well as maternal care and certain preventative measures, e.g., vaccinations (§4) [17, 18]
Summary
Background Health care utilization is structured by health care needs on one hand and the availability of accessible, acceptable high quality health care services on the other [1]. There are some health care needs particular to asylum seekers [4, 7,8,9,10]: studies have shown higher prevalence of psychiatric disorders [11,12,13], communicable diseases [3, 14, 15], and problems of maternal health [12, 16] Even though these special needs of asylum seekers are well established in the literature and the German health care system is able to provide acceptable, high quality care, with the Asylum Seekers’ Benefits Act (“Asylbewerberleistungsgesetz”, ASBA) German law creates barriers in access to health care [17]. In Germany access to health care is restricted for asylum seekers by law and administrative regulations
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