Utilisation of medical rehabilitation services by persons of working age with a migrant background, in comparison to non-migrants: a scoping review

Abstract

In Germany, an ageing population is affected by societal and political changes due to demographic transition, e.g. by a prolonged working life for older employees. Demographic change also influences persons of higher working age with a migrant background. In 2018, 25% of all employees in Germany had a migrant background. Those affected by poor health at a higher working age can benefit from medical rehabilitation services, which aim to prevent early retirement and disabilities. So far, the utilisation of medical rehabilitation has been lower among persons of foreign nationality (often the only available proxy for migrant background), compared to that of Germans. The aim of this scoping review is to assess the utilisation of medical rehabilitation services by those with migrant background (PMB) and those without (non-PMB) and to identify the differences between these groups. We included 25 studies in our analysis, which were mainly secondary analyses of routine data and also a small number of primary studies. The results were inconsistent: studies published before 2018 showed a lower use of rehabilitation services for persons of foreign nationality compared to Germans. However, no differences were found between PMB and non-PMB in studies published in 2018 or later. PMB, as well as foreign nationals, showed poorer health before medical rehabilitation utilisation and had a higher chance of occupational disease and a lower education level. We identified a lower work-related performance, as well as barriers (e.g. information deficits) in the utilisation of rehabilitation services for groups of PMB. Our review is limited in that we cannot generalise our results to all PMB living in Germany. This is because of the heterogeneity, the limited number of studies and lack of representativeness in some studies. In many cases, studies only analyse the nationality, but they lack information about the second generation PMB. Future studies should survey the utilisation of medical rehabilitation services by migrant background rather than by nationality and focus on changes in the provision of rehabilitation measures following diversity-centred strategies.

Clinical outcomes and cardiac rehabilitation in underrepresented groups after percutaneous coronary intervention: an observational study

“…44 However, a recent scoping review found inconsistent results in the utilization of medical rehabilitation services by persons of working age with a migrant background in comparison with non-migrants. 45 These inconsistencies may be due to differences in the type of rehabilitation, country-specific social inequalities, and structural characteristics of the migrant population. Therefore, our results should be interpreted according to the structure of our migrant population and the Bern circumstances, where patients from European countries represented more than 80% of the migrant population.…”

Medical rehabilitation of older employees with migrant background in Germany: Does the utilization meet the needs?

“…Such differences may be attributed to occupational and health factors, but also to lower utilization of health services such as medical rehabilitation. Until 2018, studies showed that people with a migrant background are less likely to utilize medical rehabilitation compared to those without (non-EMB) [ 27 , 31 – 33 ], possibly due to barriers such as lack of information, language problems, illiteracy, cultural aspects etc. [ 33 – 35 ].…”

“…Until 2018, studies showed that people with a migrant background are less likely to utilize medical rehabilitation compared to those without (non-EMB) [ 27 , 31 – 33 ], possibly due to barriers such as lack of information, language problems, illiteracy, cultural aspects etc. [ 33 – 35 ]. However, there were no differences found in studies published in 2018 or later, so findings are inconsistent and often lack information about the second-generation, because of the limited differentiation of migrant background [ 33 ].…”

“…[ 33 – 35 ]. However, there were no differences found in studies published in 2018 or later, so findings are inconsistent and often lack information about the second-generation, because of the limited differentiation of migrant background [ 33 ].…”

“…Yet, in Germany, such a definition leads to the misclassification of about half of all people with a migrant background as non-migrants, as 11.1 million of a total 21.2 million people with a migrant background, had German nationality in 2019 [ 2 ]. Additionally, primary studies often do not make any further differentiation between migrant groups, even when other operationalizations than nationality are used [ 33 ]. However, EMB are a heterogeneous group and should be investigated in more detail.…”