IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0131483.html
   My bibliography  Save this article

Effect of Restricting Access to Health Care on Health Expenditures among Asylum-Seekers and Refugees: A Quasi-Experimental Study in Germany, 1994–2013

Author

Listed:
  • Kayvan Bozorgmehr
  • Oliver Razum

Abstract

Background: Access to health care for asylum-seekers and refugees (AS&R) in Germany is initially restricted before regular access is granted, allegedly leading to delayed care and increasing costs of care. We analyse the effects of (a) restricted access; and (b) two major policy reforms (1997, 2007) on incident health expenditures for AS&R in 1994-2013. Methods and Findings: We used annual, nation-wide, aggregate data of the German Federal Statistics Office (1994-2013) to compare incident health expenditures among AS&R with restricted access (exposed) to AS&R with regular access (unexposed). We calculated incidence rate differences (∆IRt) and rate ratios (IRRt), as well as attributable fractions among the exposed (AFe) and the total population (AFp). The effects of between-group differences in need, and of policy reforms, on differences in per capita expenditures were assessed in (segmented) linear regression models. The exposed and unexposed groups comprised 4.16 and 1.53 million person-years. Per capita expenditures (1994–2013) were higher in the group with restricted access in absolute (∆IRt = 375.80 Euros [375.77; 375.89]) and relative terms (IRR = 1.39). The AFe was 28.07% and the AFp 22.21%. Between-group differences in mean age and in the type of accommodation were the main independent predictors of between-group expenditure differences. Need variables explained 50-75% of the variation in between-group differences over time. The 1997 policy reform significantly increased ∆IRt adjusted for secular trends and between-group differences in age (by 600.0 Euros [212.6; 986.2]) and sex (by 867.0 Euros [390.9; 1342.5]). The 2007 policy reform had no such effect. Conclusion: The cost of excluding AS&R from health care appears ultimately higher than granting regular access to care. Excess expenditures attributable to the restriction were substantial and could not be completely explained by differences in need. An evidence-informed discourse on access to health care for AS&R in Germany is needed; it urgently requires high-quality, individual-level data.

Suggested Citation

  • 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.
    • Handle: RePEc:plo:pone00:0131483
    DOI: 10.1371/journal.pone.0131483
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0131483
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0131483&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0131483?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Zachary Steel & Belinda J Liddell & Catherine R Bateman-Steel & Anthony B Zwi, 2011. "Global Protection and the Health Impact of Migration Interception," PLOS Medicine, Public Library of Science, vol. 8(6), pages 1-5, June.
    2. Cathy Zimmerman & Ligia Kiss & Mazeda Hossain, 2011. "Migration and Health: A Framework for 21st Century Policy-Making," Working Papers id:4174, eSocialSciences.
    3. Cathy Zimmerman & Ligia Kiss & Mazeda Hossain, 2011. "Migration and Health: A Framework for 21st Century Policy-Making," PLOS Medicine, Public Library of Science, vol. 8(5), pages 1-7, May.
    4. Grove, Natalie J. & Zwi, Anthony B., 2006. "Our health and theirs: Forced migration, othering, and public health," Social Science & Medicine, Elsevier, vol. 62(8), pages 1931-1942, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Petia Genkova & Pia Keysers, 2018. "Migration and Divesity Potentials for Organisations: the Case of Germany," European Journal of Business Science and Technology, Mendel University in Brno, Faculty of Business and Economics, vol. 4(1), pages 69-80.
    2. Yves Jackson & Adeline Paignon & Hans Wolff & Noelia Delicado, 2018. "Health of undocumented migrants in primary care in Switzerland," PLOS ONE, Public Library of Science, vol. 13(7), pages 1-13, July.
    3. Saleh Aljadeeah & Veronika J. Wirtz & Eckhard Nagel, 2021. "Barriers to Accessing Medicines among Syrian Asylum Seekers and Refugees in a German Federal State," IJERPH, MDPI, vol. 18(2), pages 1-16, January.
    4. 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.
    5. Yonas Semere Kidane & Sandra Ziegler & Verena Keck & Janine Benson-Martin & Albrecht Jahn & Temesghen Gebresilassie & Claudia Beiersmann, 2021. "Eritrean Refugees’ and Asylum-Seekers’ Attitude towards and Access to Oral Healthcare in Heidelberg, Germany: A Qualitative Study," IJERPH, MDPI, vol. 18(21), pages 1-20, November.
    6. Leonardo Mammana & Chiara Milani & Paola Bordin & Lorenzo Paglione & Chiara Salvia, 2020. "Health System Response during the European Refugee Crisis: Policy and Practice Analysis in Four Italian Regions," IJERPH, MDPI, vol. 17(15), pages 1-22, July.
    7. Ferdinand Garoff & Natalia Skogberg & Antti Klemettilä & Eero Lilja & Awa Ahmed Haji Omar & Olli Snellman & Anu E. Castaneda, 2021. "Mental Health and Traumatization of Newly Arrived Asylum Seeker Adults in Finland: A Population-Based Study," IJERPH, MDPI, vol. 18(13), pages 1-12, July.
    8. Kevin Claassen & Pia Jäger, 2018. "Impact of the Introduction of the Electronic Health Insurance Card on the Use of Medical Services by Asylum Seekers in Germany," IJERPH, MDPI, vol. 15(5), pages 1-11, April.
    9. Francis Bakewell & Sarah Addleman & Garth Dickinson & Venkatesh Thiruganasambandamoorthy, 2018. "Use of the emergency department by refugees under the Interim Federal Health Program: A health records review," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-8, May.
    10. Woranan Witthayapipopsakul & Hathairat Kosiyaporn & Sonvanee Uansri & Rapeepong Suphanchaimat, 2022. "Effect of the Promulgation of the New Migrant’s Employment Law on Migrant Insurance Coverage in Thailand: An Interrupted Time Series Analysis, 2016–2018," IJERPH, MDPI, vol. 19(7), pages 1-12, April.
    11. Jaschke, Philipp & Kosyakova, Yuliya, 2020. "Does facilitated access to the health system improve asylum-seekers' health outcomes? : Evidence from a quasi-experiment," IAB-Discussion Paper 201907, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany].
    12. Gottlieb, Nora & Schülle, Mirjam, 2021. "An overview of health policies for asylum-seekers in Germany," Health Policy, Elsevier, vol. 125(1), pages 115-121.
    13. Kohlenberger, Judith & Buber-Ennser, Isabella & Rengs, Bernhard & Leitner, Sebastian & Landesmann, Michael, 2019. "Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey," Health Policy, Elsevier, vol. 123(9), pages 833-839.
    14. Allen, William L. & Ruiz, Isabel & Vargas-Silva, Carlos, 2024. "Policy preferences in response to large forced migration inflows," World Development, Elsevier, vol. 174(C).
    15. Violeta Alarcão & Miodraga Stefanovska-Petkovska & Ana Virgolino & Osvaldo Santos & Andreia Costa, 2021. "Intersections of Immigration and Sexual/Reproductive Health: An Umbrella Literature Review with a Focus on Health Equity," Social Sciences, MDPI, vol. 10(2), pages 1-29, February.
    16. Porthé, Victoria & Vargas, Ingrid & Sanz-Barbero, Belén & Plaza-Espuña, Isabel & Bosch, Lola & Vázquez, Maria Luisa, 2016. "Changes in access to health care for immigrants in Catalonia during the economic crisis: Opinions of health professionals and immigrant users," Health Policy, Elsevier, vol. 120(11), pages 1293-1303.
    17. Rolke, Kristin & Wenner, Judith & Razum, Oliver, 2019. "Shaping access to health care for refugees on the local level in Germany – Mixed-methods analysis of official statistics and perspectives of gatekeepers," Health Policy, Elsevier, vol. 123(9), pages 845-850.
    18. Ulrich Trohl & Karoline Wagner & Vivian Kalfa & Sarah Negash & Andreas Wienke & Amand Führer, 2021. "Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy," IJERPH, MDPI, vol. 18(22), pages 1-15, November.
    19. Dourgnon, Paul & Pourat, Nadereh & Rocco, Lorenzo, 2023. "European immigrant health policies, immigrants’ health, and immigrants’ access to healthcare," Health Policy, Elsevier, vol. 127(C), pages 37-43.
    20. Gallagher,Allen William Andrew & Ruiz,Isabel & Vargas Silva,Carlos Ivan, 2022. "Policy Preferences in Response to Large Migration Inflows," Policy Research Working Paper Series 10055, The World Bank.
    21. Pia Jäger & Kevin Claassen & Notburga Ott & Angela Brand, 2019. "Does the Electronic Health Card for Asylum Seekers Lead to an Excessive Use of the Health System? Results of a Survey in Two Municipalities of the German Ruhr Area," IJERPH, MDPI, vol. 16(7), pages 1-9, April.
    22. Karl Puchner & Evika Karamagioli & Anastasia Pikouli & Costas Tsiamis & Athanasios Kalogeropoulos & Eleni Kakalou & Elena Pavlidou & Emmanouil Pikoulis, 2018. "Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees," IJERPH, MDPI, vol. 15(6), pages 1-6, May.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. James Smith, 2016. "Thinking beyond borders: reconceptualising migration to better meet the needs of people in transit," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 61(5), pages 521-522, June.
    2. Xiang Kang & Mingxi Du & Siqin Wang & Haifeng Du, 2022. "Exploring the Effect of Health on Migrants’ Social Integration in China," IJERPH, MDPI, vol. 19(8), pages 1-20, April.
    3. Woranan Witthayapipopsakul & Hathairat Kosiyaporn & Sonvanee Uansri & Rapeepong Suphanchaimat, 2022. "Effect of the Promulgation of the New Migrant’s Employment Law on Migrant Insurance Coverage in Thailand: An Interrupted Time Series Analysis, 2016–2018," IJERPH, MDPI, vol. 19(7), pages 1-12, April.
    4. Kudus Oluwatoyin Adebayo, 2023. "Health Challenges in Everyday Life of Nigerians in Guangzhou City, China," Journal of International Migration and Integration, Springer, vol. 24(3), pages 1477-1497, September.
    5. Adetayo Olaniyi Adeniran & Samuel Oluwaseyi Olorunfemi & Feyisola Olajire Akinsehinwa & Taye Mohammed Abdullahi, 2021. "Nexus between urban mobility and the transmission of infectious diseases: evidence from empirical review," Post-Print hal-03583997, HAL.
    6. Jordan Edwards & Kelly K. Anderson & Saverio Stranges, 2019. "Migrant mental health, Hickam’s dictum, and the dangers of oversimplification," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(4), pages 477-478, May.
    7. Osnat Keidar & David S. Srivastava & Emmanouil Pikoulis & Aristomenis K. Exadaktylos, 2019. "Health of Refugees and Migrants—Where Do We Stand and What Directions Should We Take?," IJERPH, MDPI, vol. 16(8), pages 1-8, April.
    8. 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.
    9. Lakin, Kimberly & Kane, Sumit, 2022. "Peoples’ expectations of healthcare: A conceptual review and proposed analytical framework," Social Science & Medicine, Elsevier, vol. 292(C).
    10. Tharani Loganathan & Deng Rui & Chiu-Wan Ng & Nicola Suyin Pocock, 2019. "Breaking down the barriers: Understanding migrant workers’ access to healthcare in Malaysia," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-24, July.
    11. Gracia Fellmeth & Emma Plugge & Mina Fazel & Prakaykaew Charunwattana & François Nosten & Raymond Fitzpatrick & Julie A Simpson & Rose McGready, 2018. "Validation of the Refugee Health Screener-15 for the assessment of perinatal depression among Karen and Burmese women on the Thai-Myanmar border," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-17, May.
    12. Shira M Goldenberg & Andrea Krüsi & Emma Zhang & Jill Chettiar & Kate Shannon, 2017. "Structural Determinants of Health among Im/Migrants in the Indoor Sex Industry: Experiences of Workers and Managers/Owners in Metropolitan Vancouver," PLOS ONE, Public Library of Science, vol. 12(1), pages 1-18, January.
    13. Alys McAlpine & Ligia Kiss & Cathy Zimmerman & Zaid Chalabi, 2021. "Agent-based modeling for migration and modern slavery research: a systematic review," Journal of Computational Social Science, Springer, vol. 4(1), pages 243-332, May.
    14. Acevedo-Garcia, Dolores & Sanchez-Vaznaugh, Emma V. & Viruell-Fuentes, Edna A. & Almeida, Joanna, 2012. "Integrating social epidemiology into immigrant health research: A cross-national framework," Social Science & Medicine, Elsevier, vol. 75(12), pages 2060-2068.
    15. Karl Puchner & Evika Karamagioli & Anastasia Pikouli & Costas Tsiamis & Athanasios Kalogeropoulos & Eleni Kakalou & Elena Pavlidou & Emmanouil Pikoulis, 2018. "Time to Rethink Refugee and Migrant Health in Europe: Moving from Emergency Response to Integrated and Individualized Health Care Provision for Migrants and Refugees," IJERPH, MDPI, vol. 15(6), pages 1-6, May.
    16. Corie Gray & Gemma Crawford & Bruce Maycock & Roanna Lobo, 2022. "Exploring the Intersections of Migration, Gender, and Sexual Health with Indonesian Women in Perth, Western Australia," IJERPH, MDPI, vol. 19(20), pages 1-16, October.
    17. Fleischman, Yonina & Willen, Sarah S. & Davidovitch, Nadav & Mor, Zohar, 2015. "Migration as a social determinant of health for irregular migrants: Israel as case study," Social Science & Medicine, Elsevier, vol. 147(C), pages 89-97.
    18. Arévalo, Sandra P. & Tucker, Katherine L. & Falcón, Luis M., 2015. "Beyond cultural factors to understand immigrant mental health: Neighborhood ethnic density and the moderating role of pre-migration and post-migration factors," Social Science & Medicine, Elsevier, vol. 138(C), pages 91-100.
    19. Xiaoguang Fan & Fei Yan & Wei Yan, 2020. "Better Choice, Better Health? Social Integration and Health Inequality among International Migrants in Hangzhou, China," IJERPH, MDPI, vol. 17(13), pages 1-13, July.
    20. PLoS Medicine Editors, 2011. "Human Trafficking: The Shameful Face of Migration," Working Papers id:4286, eSocialSciences.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0131483. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.