Mylius M, Frewer A
Professur für Ethik in der Medizin, Institut für Geschichte und Ethik der Medizin, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen.
Gesundheitswesen. 2014 Jul;76(7):440-5. doi: 10.1055/s-0033-1364014. Epub 2014 Mar 26.
Public welfare on a municipal level for groups with special health risks has been an important topic of public health service for more than a century. This notion has been taken up by the German "Protection against Infection Act" (IfSG) in § 19 IfSG. Local health service authorities may provide out-patient treatment in addition to counselling and diagnosis for patients with sexually transmitted infections and tuberculosis, which is covered by public resources in cases of apparent need. Due to altered legislation and increased global mobility, this may become important for migrants without access to regular health care.Aims of this study were recording, counselling, diagnosis and out-patient treatment of migrants without legal residence status under the German Protection against Infection Act in the public health care system.An electronic mail survey of all local health authorities (n=384) by means of a standardised questionnaire was undertaken. Data were analysed using descriptive statistics. In the annex of the questionnaire the participants were asked to describe a case study.139 of 384 local health authorities completed the questionnaire (36.2%) of whom approximately a quarter (24.6%) described contacts to "illegal" migrants. Contacts to migrants without legal residence status are more frequent in cities with more than 100,000 inhabitants than in ismaller cities (p<0.05). 22.6% of all local health authorities make an effort to reach undocumented migrants for counseling and diagnosis. 25 of the local health authorities (18.4%) indicated the capability to provide treatment in accordance with § 19 IfSG. A majority of these local health authorities also have contacts to undocumented migrants (75%). 16 local health authorities (13.3%) provide out-patient treatment for diseases not listed in Protection against Infection Act. 56 authorities (46.7%) refer patients to aid organisations or to resident doctors.Only a small number of local health authorities have contacts to migrants without health insurance. The option-al out-patient treatment is provided by few local health authorities especially in cases of sexual transmitted diseases except for HIV/AIDS. In most cases undocumented migrants are only one group among others. The large number of cases in cities with more than 500,000 inhabitants shows the massive requirements.
一个多世纪以来，市级针对具有特殊健康风险群体的公共福利一直是公共卫生服务的重要议题。这一理念已被德国《感染防护法》（IfSG）第19条所采纳。地方卫生服务当局除了为性传播感染和结核病患者提供咨询和诊断外，还可提供门诊治疗，在明显需要的情况下，公共资源会对此予以覆盖。由于立法的变化和全球流动性的增加，这对于无法获得常规医疗保健的移民来说可能变得至关重要。本研究的目的是在公共卫生保健系统中，依据德国《感染防护法》对无合法居住身份的移民进行记录、咨询、诊断和门诊治疗。通过标准化问卷对所有地方卫生当局（n = 384）进行了电子邮件调查。使用描述性统计方法对数据进行了分析。在问卷附录中，要求参与者描述一个案例研究。384个地方卫生当局中的139个完成了问卷（36.2%），其中约四分之一（24.6%）描述了与“非法”移民的接触情况。在人口超过10万的城市中，与无合法居住身份移民的接触比在较小城市更为频繁（p < 0.05）。所有地方卫生当局中有22.6%努力联系无证移民以提供咨询和诊断。25个地方卫生当局（18.4%）表示有能力依据《感染防护法》第19条提供治疗。这些地方卫生当局中的大多数也与无证移民有接触（75%）。16个地方卫生当局（13.3%）为《感染防护法》未列出的疾病提供门诊治疗。56个当局（46.7%）将患者转介给援助组织或驻地医生。只有少数地方卫生当局与无医疗保险的移民有接触。很少有地方卫生当局提供选择性门诊治疗，尤其是在性传播疾病（除艾滋病毒/艾滋病外）方面。在大多数情况下，无证移民只是其他群体中的一部分。在人口超过50万的城市中大量的案例表明了巨大的需求。
