Technical University Berlin, Department of Health Care Management (H80), Straße des 17. Juni 135, 10623 Berlin, Germany; Bielefeld University, Bielefeld School of Public Health, Department of Population Medicine and Health Services Research (AG2), Bielefeld, Germany.
Humboldt University of Berlin, Faculty of Humanities and Social Sciences, Department of Rehabilitation Science, Germany.
Health Policy. 2021 Jan;125(1):115-121. doi: 10.1016/j.healthpol.2020.09.009. Epub 2020 Oct 19.
Health policies for asylum-seekers are a subject of debate across European countries. However, information on current strategies to respond to these populations' health needs is scarce. To facilitate comparative research, this paper renders a detailed overview of Germany's asylum-seeker health policies. Following a description of the historic development and administrative structure of asylum-seeker health care in Germany, we provide a detailed account of asylum-seekers' scope of health entitlements, as it is defined by federal law. We explain the main mechanisms that are used to implement the law on local levels and regulate health care access; namely, the electronic health insurance card and the health care voucher. Financing and billing structures are described, and main points of critique of Germany's asylum-seeker health policies are summarized. Our description highlights fragmentation and internal variations as central features of Germany's asylum-seeker health policies. It explicates how these features are rooted in decentralization, and in the regulation of restricted health benefits through a parallel system, separate from statutory health insurance. As a case-study, Germany's asylum-seeker health policies illustrate the administrative, economic and ethical burdens implied in granting health benefits through a parallel system, and in absence of central health governance. The (re)integration of asylum-seeker health care in statutory health insurance could reduce these burdens and contribute to equitable health care access.
寻求庇护者的健康政策是欧洲各国争论的一个话题。然而,关于应对这些人群健康需求的当前策略的信息却很少。为了便于比较研究,本文详细介绍了德国寻求庇护者健康政策。在描述了德国寻求庇护者医疗保健的历史发展和行政结构之后,我们详细介绍了联邦法律所定义的寻求庇护者的健康权益范围。我们解释了在地方层面实施法律和规范医疗保健准入的主要机制;即电子健康保险卡和医疗保健券。本文还描述了融资和计费结构,并总结了德国寻求庇护者健康政策的主要批评观点。我们的描述强调了碎片化和内部差异是德国寻求庇护者健康政策的核心特征。它阐明了这些特征如何植根于权力下放,以及通过平行系统对有限的健康福利进行监管,与法定健康保险分开。作为一个案例研究,德国寻求庇护者健康政策说明了通过平行系统和缺乏中央卫生治理来提供健康福利所涉及的行政、经济和伦理负担。将寻求庇护者的医疗保健纳入法定健康保险中,可以减轻这些负担,并有助于实现公平的医疗保健准入。