Asylum seekers in Germany only have limited access to medical care, an attempt by the state to keep costs low, but a new study shows health-related costs are much lower when refugees can freely access health services. EURACTIV Germany reports.
In most of the German Länder, asylum seekers are not allowed to go directly to doctors when they are in pain or call an ambulance after an accident. Instead, they are required to get a permit first from the appropriate authorities or the refugee centre.
This procedure is regulated by the Asylum Seekers Benefits Act of 1993. The goal of the law is to keep health-related spending low and limit incentives for asylum seekers in Germany.
The law has been controversial since its conception. But now a study conducted by researchers at the Heidelberg University Hospital and the University of Bielefeld, published in the academic journal PLOS ONE, indicates that its economic purposes do not make sense either.
In a detailed examination of health-related costs for refugees in Germany between 1994 and 2013, the researchers showed that the existing regulation racks up additional costs. Annual per capita expenditures over the past 20 years for medical care among asylum seekers with restricted access were 40% higher (€376) than for asylum seekers who already had access to services under Germany’s statutory health insurance.
“The discussion over healthcare for asylum seekers has been purely political so far,” said Kayvan Bozorgmehr, the researcher from the Heidelberg University Hospital. “There is an urgent need for rational, health-related findings and ethical standards to be taken more into consideration,” the author of the study warned.
Entitled to full coverage after 15 months
Up till now, asylum seekers have only been entitled to treatment if they are suffering from acute health problems, are in pain or if a treatment can no longer be postponed. These individuals are only given full coverage under statutory health insurance after a 15 month stay in Germany. This affects hundreds of thousands of asylum applicants in the Federal Republic.
According to UNHCR statistics, around 73,000 first-time asylum applications were submitted to German authorities in 2014. Meanwhile, 200,000 applications have already been received this year.
For the study, the researchers evaluated representative data from the Federal Statistical Office collected from 1994 to 2013. They were able to demonstrate that lower health costs result from asylum applicants being able to seek out general practitioners, family doctors and pediatricians without the bureaucratic hurdles and without restrictions to services.
If all asylum seekers had the same access to the healthcare system, total spending for medical care over the past 20 years could have been cut by 22%. But sometimes differences in demand – as measured by age, gender, continent of origin and type of housing – were not entirely able to explain differences in expenditures from one year to the next.
Ensure accessibility to standard care as early as possible
In this context, the researchers argued that the regulation should be adjusted to resemble those in Bremen and Hamburg. There, asylum seekers receive a health card without a waiting period and are thereby provided with better access to healthcare, they argued.
“Our study proves that national implementation of the Bremen Model – which has been free of bureaucratic obstacles since 2005 – does not necessarily have to be accompanied by more costs,” said the co-author of the study Oliver Razum from the University of Bielefeld.
It is important to ensure accessibility to basic care, Razum emphasised, thereby offering comprehensive care with primary medical services as early as possible. This is not only ethically advisable, but also takes into account health-related findings which, he said, are undisputed internationally by now.
“Good quality, needs-based and cost-effective care is most achievable through integrated, primary medicine-oriented systems,” Razum’s colleague Bozorgmehr said.
But parallel systems are expensive and inefficient, especially when they exclude certain groups within the population from care, he argued.
The researchers argued that data on healthcare among asylum seekers be more readily available to identify needs within the healthcare system and to evaluate care itself.
The EU has been working to create a Common European Asylum System to deal with immigration for political or humanitarian reasons since 1999.
New EU rules have now been agreed, setting out common standards and co-operation to ensure that asylum seekers are treated equally in an open and fair system – wherever they apply.
But EU countries rejected a European Commission proposal for more shared responsibility in dealing with asylum requests and that immigrants arriving in the countries with a disproportionate share should be relocated to other EU member states.
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