Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?

Abstract

Background The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care. Methods A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti. Results Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time. Conclusions Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system. Key messages The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.