Black African asylum seekers’ experiences of health care access in an eastern German state

Abstract

Purpose – The purpose of this paper is to examine how access to health care for (rejected) asylum seekers in an eastern German state is structured and experienced and to consider the implications for their human rights. Design/methodology/approach – The paper is based on 12 in-depth interviews with rejected black African asylum seekers and also draws on ethnographic research undertaken at a grassroots refugee organisation and asylum homes. The analysis of the interview data are framed by theorisations of “everyday practices” as “tactics” of resistance to an imposed order. Findings – Accomplishing health care access involved a range of structural barriers and humiliating interactions with administrative and health care staff, which had adverse consequences for their health status and were injurious to their human rights and dignity. The study participants used a range of oppositional and discursive tactics in an effort to secure certain (health) outcomes, mediate social relations and resist their domination as asylum seekers. Research limitations/implications – Further research should focus on the cumulative micro-level effects of asylum policies on health care access and how they create health inequities and violate asylum seekers’ rights and dignity. Practical implications – Policy priorities should include the provision of human rights education as well as training and support for administrative and health staff. Originality/value – There is limited qualitative research on the health care experiences of asylum seekers in Germany. This paper makes policy recommendations and identifies areas for further research and human rights advocacy.

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

“…Halle (Saale) is a medium-sized city with approximately 240,000 inhabitants, located in the east of Germany. Being an urban area, the density of medical facilities is high, and public transport is readily available, different from other more rural districts, where limited mobility has been described as a factor impairing asylum seekers' utilization of health care [10,23,37]. To our knowledge, other structural mediating factors of access to health care do not differ much from other districts in Germany.…”

“…Emergency treatments can be provided without prior application, but the care provider has to apply for cost reimbursement later. All these applications are then checked by the medically untrained staff of the social services office [10,37]. If approved, the social services office reimburses the care providers after receiving the bills.…”

“…Access to health care for asylum seekers is complicated by structural factors such as language barriers or limited knowledge about the health system. In addition, with the exclusion of asylum seekers from the statutory health insurance through the ASBA and its various translations into practice, German health care policy has created artificial barriers in the access to health care for asylum seekers [10,19,37]. We suspect effects of these barriers in the utilization of health care services by our study population: When comparing our cohort of asylum seekers to the regularly insured German population [51], we found similar patterns in age and gender distribution contrasting consistently lower numbers of utilization of outpatient care across all age and gender groups.…”

“…Previous studies have shown a high unmet need of treatment of such conditions and a tendency among mentally ill asylum seekers to report with somatic symptoms [72]. Another explanation might lie in the wording of the ASBA, stating in its first paragraph that asylum seekers are entitled to treatment for "acute and painful conditions" [17], which might lead physicians towards treating symptomatically with pain medication, especially when in uncertainty about actual entitlement regulations for their patients [24] or when unwilling or unable to engage for their patients to facilitate equitable treatment and to overcome barriers in access to adequate health care [26,37]. Researchers working on asylum seekers' perceptions of the health care system have described frequent pain killer prescriptions as a symbol for "the lack of interest of and the rejection by the health care system" [73], as they found pain killer prescription being a common trait among failed doctor-patient interactions with asylum seekers [37].…”

Health and Healthcare Utilization among Asylum-Seekers from Berlin’s LGBTIQ Shelter: Preliminary Results of a Survey

“…The PSZs report waiting times of up to two years and a 40% rejection rate [13]. Communication barriers and negative attitudes of administrative and healthcare staff have been described as additional deterrents to healthcare-seeking [14,15].…”