Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis

Lichtl, Celina; Gewalt, Sandra Claudia; Noest, Stefan; Szécsényi, Joachim; Bozorgmehr, Kayvan

doi:10.1136/bmjopen-2016-012216

Cited by 6 publications

(6 citation statements)

References 29 publications

(24 reference statements)

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“…In the process of a systematic review on potentially avoidable and ACS hospitalizations among forced migrants [ 35 ], only few empirical studies have been found on ACS conditions and hospitalizations among asylum seekers and the broader population group of forced migrants. Preliminary results indicate that the indicator has not been widely used to display differences and disparities in access to ambulatory care among forced migrants and the domestic population.…”

Section: Discussionmentioning

confidence: 99%

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Lichtl

Lutz

Szécsényi

et al. 2017

BMC Health Serv Res

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BackgroundHospitalizations for ambulatory care sensitive (ACS) conditions are established indicators for the availability and quality of ambulatory care. We aimed to assess the differences between asylum-seeking children and children of the general population in a German city with respect to (i) the prevalence of ACS hospitalizations, and (ii) the utilization of emergency outpatient services for ACS conditions.MethodsUsing anonymous account data, all children admitted to the University Hospital Heidelberg in 2015 were included in our study. A unique cost unit distinguished asylum seekers residing in a nearby reception center (exposed) from the children of the general population. We adapted international lists of ACS conditions and calculated the prevalence of ACS hospitalizations and the utilization of emergency outpatient services for ACS conditions, attributable fractions among the exposed (Afe) and the population attributable fraction among total admissions (PAF) for each outcome. Differences in the prevalence of each outcome between exposed and controls were analyzed in logistic regression models adjusted for sex, age group and quarterly admission.ResultsOf the 32,015 admissions in 2015, 19.9% (6287) were from inpatient and 80.1% (25,638) from outpatient care. In inpatient care, 9.8% (622) of all admissions were hospitalizations for ACS conditions. The Afe of ACS hospitalizations was 46.57%, the PAF was 1.12%. Emergency service use for ACS conditions could be identified in 8.3% (3088) of all admissions (Afe: 79.57%, PAF: 5.08%). The odds ratio (OR) of asylum-seeking children being hospitalized for ACS conditions in comparison to the control group was 1.81 [95% confidence interval, CI: 1.02; 3.2]. The OR of the asylumseeking population compared to the general population for the utilization of emergency service use for ACS conditions was 4.93 [95% CI: 4.11; 5.91].ConclusionsAsylum-seeking children had significantly higher odds of ACS hospitalization and of utilization of emergency outpatient services for ACS conditions. Using the concept of ACS conditions allowed measuring the strength of primary care provided to this local asylum-seeking population. This approach could help to compare the strength of primary care provision in different locations, and allow an objective.

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Section: Discussionmentioning

confidence: 99%

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Lichtl

Lutz

Szécsényi

et al. 2017

BMC Health Serv Res

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“…Similarly, in a survey among internal medicine specialists in Germany, a considerable proportion reported not being familiar with the HcV regulations and the ASBA [14]. Quantitative studies reported high unmet needs among adult refugees [15], high odds of emergency department use and avoidable hospitalizations among refugee children compared to non-refugees [16,17]. 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].…”

Section: Introductionmentioning

confidence: 98%

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

et al. 2020

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Background: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. Methods: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasiexperiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. Results: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. Conclusion: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.

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“…10 They further note that timely access to outpatient care can hold economic benefits; for example, due to the early detection and treatment of ambulatory care sensitive conditions in the outpatient sector. 11 This is supported by a growing body of research. [11][12][13][14] The main arguments put forward in favour of the HIC, however, are of normative nature, as they relate to governments' legal and moral duty to provide equitable and non-discriminatory access to healthcare.…”

Section: Healthcare Provision For Asylum-seekers In Germanymentioning

confidence: 97%

“…11 This is supported by a growing body of research. [11][12][13][14] The main arguments put forward in favour of the HIC, however, are of normative nature, as they relate to governments' legal and moral duty to provide equitable and non-discriminatory access to healthcare. 5,15,16 Our study uses the recent introduction of the HIC in Berlin as an opportunity to empirically test some of the above described arguments.…”

Section: Healthcare Provision For Asylum-seekers In Germanymentioning

confidence: 97%

The Electronic Health Insurance Card for Asylum-Seekers in Berlin: Effects on the Local Health System

Gottlieb

Ohm²,

Knörnschild³

2021

Int J Health Policy Manag

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Background: In debates on asylum-seekers’ access to healthcare it is frequently claimed that restrictions are necessary to prevent unduly high health service utilization and costs. Within Germany, healthcare provision for asylum-seekers varies across the different states. Berlin’s authorities removed some barriers to healthcare for asylum-seekers by introducing an electronic health insurance card (HIC) in 2016. We used the HIC introduction in Berlin as an opportunity to investigate the effects of improved healthcare access for asylum-seekers on the local health system. Methods: The study applied a mixed-methods design. A cost analysis compared expenses for outpatient and inpatient health services for asylum-seekers before and after the HIC introduction, based on aggregate claims data and information on expenses for humanitarian healthcare provision that were retrieved from the Berlin authorities. Semi-structured interviews with 12 key informants explored organizational effects like administrative workloads and ethical dilemmas for staff. We performed a content analysis and used respondent validation to enhance the accuracy and trustworthiness of our results. Results: The HIC has reduced bureaucratic complexity and administrative workloads; it has enabled unprecedented financial transparency and control; and it has mitigated ethical tensions. All the while, average per person expenses for outpatient health services have declined since the HIC introduction. However, our cost analysis also indicates a rise in the utilization and costs of inpatient care. Conclusion: The HIC introduction in Berlin suggests that the removal of barriers to healthcare for asylum-seekers can create win-win-situations by reducing administrative workloads, advancing financial transparency, and mitigating ethical tensions, whilst cutting the costs of outpatient healthcare provision. Removing barriers to healthcare thus appears to be a more prudent policy choice than maintaining mechanisms of restriction and control. However, high inpatient care utilization and costs warrant further research.

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Potentially avoidable and ambulatory care sensitive hospitalisations among forced migrants: a protocol for a systematic review and meta-analysis

Cited by 6 publications

References 29 publications

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

Differences in the prevalence of hospitalizations and utilization of emergency outpatient services for ambulatory care sensitive conditions between asylum-seeking children and children of the general population: a cross-sectional medical records study (2015)

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

The Electronic Health Insurance Card for Asylum-Seekers in Berlin: Effects on the Local Health System

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