Abstract
In Germany, an ageing population is affected by societal and political changes due to demographic transition, e.g. by a prolonged working life for older employees. Demographic change also influences persons of higher working age with a migrant background. In 2018, 25% of all employees in Germany had a migrant background. Those affected by poor health at a higher working age can benefit from medical rehabilitation services, which aim to prevent early retirement and disabilities. So far, the utilisation of medical rehabilitation has been lower among persons of foreign nationality (often the only available proxy for migrant background), compared to that of Germans. The aim of this scoping review is to assess the utilisation of medical rehabilitation services by those with migrant background (PMB) and those without (non-PMB) and to identify the differences between these groups. We included 25 studies in our analysis, which were mainly secondary analyses of routine data and also a small number of primary studies. The results were inconsistent: studies published before 2018 showed a lower use of rehabilitation services for persons of foreign nationality compared to Germans. However, no differences were found between PMB and non-PMB in studies published in 2018 or later. PMB, as well as foreign nationals, showed poorer health before medical rehabilitation utilisation and had a higher chance of occupational disease and a lower education level. We identified a lower work-related performance, as well as barriers (e.g. information deficits) in the utilisation of rehabilitation services for groups of PMB. Our review is limited in that we cannot generalise our results to all PMB living in Germany. This is because of the heterogeneity, the limited number of studies and lack of representativeness in some studies. In many cases, studies only analyse the nationality, but they lack information about the second generation PMB. Future studies should survey the utilisation of medical rehabilitation services by migrant background rather than by nationality and focus on changes in the provision of rehabilitation measures following diversity-centred strategies.
Highlights
Demographic transition is accompanied by societal and political changes, such as an ageing labour force, the increase of the statutory retirement age and a prolonged working life for older employees
In Germany, the German statutory pension insurance scheme is the main provider for rehabilitative care
In 2018, the German statutory pension insurance provided about 1.03 million rehabilitation measures
Summary
Demographic transition is accompanied by societal and political changes, such as an ageing labour force, the increase of the statutory retirement age (from 65 to 67 years, §35 BGB) and a prolonged working life for older employees. The objective of medical rehabilitation is to prevent early retirement by improving physical and mental health. In Germany, the German statutory pension insurance scheme is the main provider for rehabilitative care. Other providers are the statutory accident insurance (in the event of occupational accidents) and health insurances. These providers cover the costs for rehabilitation measures. In Germany, an insured person can access medical rehabilitation after being referred by their physician [4,5,6]. In 2018, the German statutory pension insurance provided about 1.03 million rehabilitation measures. The average age of rehabilitation users was 53.5 years for women and 53.4 years for men [7]
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