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Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities

Author

Listed:
  • Lukas Kratzsch

    (Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany)

  • Kayvan Bozorgmehr

    (Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
    Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany)

  • Joachim Szecsenyi

    (Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany)

  • Stefan Nöst

    (Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany
    Faculty of Business and Health, School of Health Sciences and Management, Baden-Wuerttemberg Cooperative State University Stuttgart, 70178 Stuttgart, Germany)

Abstract

Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities’ role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany.

Suggested Citation

  • Lukas Kratzsch & Kayvan Bozorgmehr & Joachim Szecsenyi & Stefan Nöst, 2022. "Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities," IJERPH, MDPI, vol. 19(11), pages 1-18, May.
    • Handle: RePEc:gam:jijerp:v:19:y:2022:i:11:p:6613-:d:826843
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    References listed on IDEAS

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    1. Silvia Loi & Daniela Vono de Vilhena, 2020. "Exclusion through statistical invisibility. An exploration on what can be known through publicly available datasets on irregular migration and the health status of this population in Germany," MPIDR Working Papers WP-2020-009, Max Planck Institute for Demographic Research, Rostock, Germany.
    2. Kayvan Bozorgmehr & Oliver Razum, 2015. "Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013," PLOS ONE, Public Library of Science, vol. 10(7), pages 1-22, July.
    3. D. Lanari & O. Bussini & L. Minelli, 2015. "Self-perceived health among Eastern European immigrants over 50 living in Western Europe," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 60(1), pages 21-31, January.
    4. Daniel T Myran & Rachael Morton & Beverly-Ann Biggs & Irene Veldhuijzen & Francesco Castelli & Anh Tran & Lukas P Staub & Eric Agbata & Prinon Rahman & Manish Pareek & Teymur Noori & Kevin Pottie, 2018. "The Effectiveness and Cost-Effectiveness of Screening for and Vaccination Against Hepatitis B Virus among Migrants in the EU/EEA: A Systematic Review," IJERPH, MDPI, vol. 15(9), pages 1-19, September.
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