Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey

Kohlenberger, Judith; Buber‐Ennser, Isabella; Rengs, Bernhard; Leitner, Sebastian; Landesmann, Michael

doi:10.1016/j.healthpol.2019.01.014

Cited by 97 publications

(82 citation statements)

References 27 publications

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“…We also see a high share of costs generated through emergency hospitalization. This is in line with former research, showing high prevalences of hospitalization [67,76] and high costs of inpatient health-care [54,65] among asylum seekers. To reverse this shift back to the costefficient arena of primary and preventative care, this calls for initiatives to provide timely and adequate care both in the receiving country and along the migration routes to reduce the morbidity and health care costs in the long term [22,28].…”

Section: Cost Analysessupporting

confidence: 92%

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Niedermaier

Freiberg

Tiller

et al. 2020

BMC Health Serv Res

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Background Asylum 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. Methods Using 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. Results The 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. Conclusion The 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.

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Section: Cost Analysessupporting

confidence: 92%

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Niedermaier

Freiberg

Tiller

et al. 2020

BMC Health Serv Res

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“…Furthermore, our study included all medical encounters that took place in one central medical ward of our camp, while in other studies, such as in that by Hermans et al, multiple medical organizations provided health services to the population which may have led to incomplete or inconsistent recording of healthcare-seeking behavior in all children and adolescents. Furthermore, in other studies, barriers like vouchers, out-of-camp medical facilities, or language barriers may have hindered access to medical care [20,21]. The barriers in our setting were comparably low since onsite access to healthcare with interpreters was actively supported in our refugee housing situation.…”

Section: Discussionmentioning

confidence: 84%

Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis

Happle

Dopfer

Ernst

et al. 2019

IJERPH

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Background: Currently, half of the population displaced worldwide is children and adolescents. Little is known on healthcare demand in underage migrants. Materials and Methods: We analyzed healthcare utilization in n = 1.411 children and adolescents living in a large German refugee reception in 2015-2016. Results: The mean age of all included refugees was 9 years (60.8% male). The majority came from the eastern Mediterranean region. During a mean camp inhabitance of 34 days, 57.6% needed primary healthcare, with a significant inverse correlation of healthcare seeking frequency with age and duration of camp inhabitance. Infants and unaccompanied minors displayed particular high demands for medical help. Discussion: Our analysis showed that pediatric primary healthcare in pediatric and adolescent refugees are most sought during the first period upon arrival with particular demand in infants, toddlers, and unaccompanied minors. Based on this data, future care taking strategies should be adapted accordingly.

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“…22,23 Moreover, healthcare and treatment needs might not be met to the same extent for refugees as for natives. 24 Adequate care in immigrants and refugees might be hampered by language barriers, differences in the clinical manifestation and symptom course of the underlying disease, and consequently in its diagnostics, as well as the lack of competence in transcultural psychiatry and psychology in the healthcare settings of the host country. 25…”

Section: Mental Disorders and Suicide Attempt And Suicide In Refugeesmentioning

confidence: 99%

Mental disorders, suicide attempt and suicide: differences in the association in refugees compared with Swedish-born individuals

et al. 2019

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BackgroundMental disorders are associated with an elevated risk for suicide attempt and suicide. Whether the strength of the associations also holds for refugees is unclear.AimsTo examine the relationship between specific mental disorders and suicide attempt and suicide in refugees and Swedish-born individuals.MethodThis longitudinal cohort study included 5 083 447 individuals aged 16–64 years, residing in Sweden in 2004, where 196 757 were refugees. Mental disorders were defined as having a diagnosis in psychiatric care during 2000–2004. Estimates of risk of suicide attempt and suicide were calculated as hazard ratios with 95% confidence intervals. Adjustments were made for important confounding factors, including history of attempt. The reference group comprised Swedish-born individuals without mental disorders.ResultsRates for suicide attempt in individuals with a mental disorder were lower in refugees compared with Swedish-born individuals (480 v. 850 per 100 000 person-years, respectively). This pattern was true for most specific disorders: compared with the reference group, among refugees, multivariable-adjusted hazard ratios for suicide attempt ranged from 3.0 (anxiety) to 7.4 (substance misuse), and among Swedish-born individuals, from 4.9 (stress-related disorder) to 9.3 (substance misuse). For schizophrenia, bipolar disorder and personality disorder, estimates for suicide attempt were comparable between refugees and Swedish-born individuals. Similar patterns were seen for suicide.ConclusionsFor most mental disorders, refugees were less likely to be admitted to hospital for suicide attempt or die by suicide compared with Swedish-born individuals. Further research on risk and protective factors for suicide attempt and suicide among refugees with mental disorders is warranted.Declaration of interestNone.

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Barriers to health care access and service utilization of refugees in Austria: Evidence from a cross-sectional survey

Cited by 97 publications

References 27 publications

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Pediatric Healthcare Utilization in a Large Cohort of Refugee Children Entering Western Europe During the Migrant Crisis

Mental disorders, suicide attempt and suicide: differences in the association in refugees compared with Swedish-born individuals

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