Department of General Practice and Health Services Research, University Hospital Heidelberg, 69120 Heidelberg, Germany.
Department of Population Medicine and Health Services Research, School of Public Health, Bielefeld University, 33501 Bielefeld, Germany.
Int J Environ Res Public Health. 2022 May 28;19(11):6613. doi: 10.3390/ijerph19116613.
Non-governmental organisations (NGOs) regularly report data on their work with uninsured migrants (UM) within a (so-called) parallel health care system. The role and involvement of public authorities therein have yet been underrepresented in research. Our aim was to gain a better understanding of public authorities' role in the parallel health care system and their view of the health situation of UM. We conducted qualitative semi-structured interviews with 12 experts recruited by purposive sampling from local public health authorities (LPHAs), state-level public health authorities (SPHAs), and social services offices (SSO) in nine cities, recorded, transcribed, and subjected the data to qualitative content analysis. LPHAs are more often directly involved in providing medical services, while SSOs and SPHAs function as gatekeepers for access to social benefits, including health insurance, and in grant-funded projects. NGOs keep substituting for the lack of access to regular health care from public institutions, but even in settings with extended services, public authorities and NGOs have not been able to provide sufficient care through the parallel health care system: Experts report gaps in the provision of health care with respect to the depth and height of coverage, due to the fragmentation of services and (ostensible) resource scarcity. Our study highlights the necessity for universal access to regular health care to overcome the fragmentation of services and improve access to needed health care for UM in Germany.
非政府组织（NGO）经常报告其在所谓的平行医疗体系中为无保险移民（UM）开展工作的数据。然而，在研究中，公共当局在其中的作用和参与程度仍然不足。我们的目的是更好地了解公共当局在平行医疗体系中的作用及其对 UM 健康状况的看法。我们采用目的抽样法从九个城市的地方公共卫生当局（LPHAs）、州级公共卫生当局（SPHAs）和社会服务办公室（SSO）中招募了 12 名专家进行了定性半结构化访谈，对访谈进行了录音、转录，并对数据进行了定性内容分析。LPHAs 更经常直接参与提供医疗服务，而 SSO 和 SPHAs 则作为获得社会福利（包括医疗保险）和赠款资助项目的准入的把关者。非政府组织一直在替代公共机构无法提供的正规医疗服务，但即使在服务范围扩大的情况下，公共当局和非政府组织也未能通过平行医疗体系提供足够的护理：专家报告称，由于服务碎片化和（表面上的）资源短缺，医疗服务的提供存在差距，包括覆盖范围的深度和广度。我们的研究强调了普及正规医疗保健的必要性，以克服服务碎片化问题，并改善德国 UM 获得所需医疗保健的机会。
