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

Abstract

Background: The initial and intermediate-term access of refugees to healthcare in Germany is limited. A previous study showed that the obligation to request healthcare vouchers at the social security offices decreases the asylum seekers’ consultation rate of ambulant physicians. The introduction of the Electronic Health Insurance Card (EHIC) for asylum seekers is considered skeptically by some municipalities and federal states, among other reasons due to the fear of an overuse of health care services by asylum seekers. The aim of this study is to further evaluate the data of the authors’ initial study with a new focus on inpatient care as well as a differentiation of the ambulant consultation rate into general practitioners and outpatient specialists. Methods: The now-differentiated consultation rate of the initial study as well as the asylum seekers’ use of inpatient care are compared to the values of the sex- and age-corrected autochthonous population as given by the German Health Interview and Examination Survey for Adults (DEGS1). A mean difference test (student’s t-test) is used for comparison and significance testing. Results: Asylum seekers who were in possession of the EHIC were significantly less likely to visit their ambulant general practitioners and specialists than the German autochthonous population. Simultaneously, this difference is partly compensated for by their more frequent use of impatient care. Conclusions: There is no indication that the EHIC leads to an overuse of healthcare services.

Differences in realized access to healthcare among newly arrived refugees in Germany: results from a natural quasi-experiment

“…Our results showed that under restricted entitlements, the access model is associated with differences in specialist and emergency service use, but not with hospitalizations due to an ACSC. The differences attributable to the access model were smaller than differences found in comparisons of groups with restricted entitlements and regular SHI-like access [19,20,44]. We therefore assume that the entitlement restrictions for refugees exert higher influence on realized access than the local access model used.…”

“…Given the absence of differences for ACSC and the advantages of the eHC for outpatient use, the results should help to overcome wrong concerns of opponents of the eHC model who had anticipated that it might lead to an inadequate overuse of healthcare services among refugees [19,41]. Both models are implemented in other federal states of Germany in a similar way.…”

“…So far, only one study directly compared healthcare use of refugees using different access models by means of a regional survey, showing an underuse of outpatient healthcare among refugees using the HcV model when compared to refugees who were using the eHC model [18]. However, from other studies comparing health service use among regularly insured patients in Germany to refugee patients, even refugees that have been issued eHCs less frequently used outpatient care, especially specialized care and mental health services [19,20]. At the same time, higher rates of avoidable hospitalizations compared to regularly SHI-insured were reported [20].…”

Der Zugang zu gesundheitlicher Versorgung nach Einführung der elektronischen Gesundheitskarte: die Sicht geflüchteter Patient(inn)en

“…Dies könnte dazu führen, dass Patient(inn)en zum einen die Inanspruchnahme ambulanter Versorgung verzögern und zum anderen vermehrt Notfallversorgungsangebote in Anspruch nehmen [21,22]. Eine standardisierte Befragung von Geflüchteten lieferte erste Hinweise, dass das eGK-Modell zu einer angemessenen Nutzung der gesundheitlichen Versorgung beitragen kann [23].…”

Health and Healthcare Utilization among Asylum-Seekers from Berlin’s LGBTIQ Shelter: Preliminary Results of a Survey

“…Unspecific symptoms that are often related to psychological distress, such as back pain and headaches, are highly prevalent and have been linked to somatization [ 8 ]. Asylum-seekers were shown to frequently seek healthcare from general practitioners, yet some studies point to underutilization of specialist health services [ 6 , 7 , 8 , 9 ]. High hospitalization rates, including high rates of ambulatory care-sensitive hospitalizations, have been reported [ 6 , 7 ].…”