Comparable worth of life for all? Conducting and disseminating health economic evaluations for refugees in Germany

Abstract

Comparative health economic evaluation is based on premise of being able to compare the worth of a year of life lived in full quality across different patients, population groups, settings and interventions. Given the rising numbers of forcibly displaced people, the nexus of economics, migration and health has emerged as a central theme in recent conceptual and empirical approaches. However, some of the assumptions made in conventional economic approaches do not hold true in the decision-making context of migration and the health of forcibly displaced populations. Using the experience of conducting and disseminating economic analyses to support decision-making on health screening policies for refugees in Germany, we show that in particular the assumptions of individual utility with no positive externalities, equity-blind utilitarian ethical stances and stable budgets are challenged. The further development of methods to address these challenges are required to support decision-makers in this contentious and politically fraught context and continue to make choices and decisions transparent.

Integration of migrant and refugee data in health information systems in Europe: advancing evidence, policy and practice

“…Health systems and health information systems (HIS) are often limited by their focus on stable populations 66 within individual countries, 1 , 9 overlooking the complexities of migration 67 , 68 and the need for sharing data across sectors 9 and borders. 69 , 70 , 71 To address this, data sources for HIS ( Fig.…”

Making an economic argument for investment in global mental health: The case of conflict-affected refugees and displaced people

“…Ensure economic evaluations consider impacts that are of relevance to funders Economic evaluations need to take account of outcomes and goals that are of particular relevance to their funders. This can be complex, as there may be entirely separate and uncertain funding streams for refugee health services even in HICs, as in Germany where responsibility for funding services is fragmented between different administrative bodies in different regions (Biddle et al, 2022). Many LMICs rely on what can be uncertain and time-limited levels of external donor aid from HICs, as well as direct financial support from the United Nations High Commissioner for Refugees (UNHCR) and other international agencies (Spiegel et al, 2018).…”

“…These concerns over pressure on health systems can also be visible in HICs, who may be reluctant to even receive refugees, despite their legal obligations. Domestic politics might also play a role, with a reluctance of some politicians to be seen to be funding services for refugees (Biddle et al, 2022 ).…”

Impacto socioeconómico de la migración en Cuba, 2022

“…El impacto en la utilización de los servicios sanitarios de las variables sociodemográficas, estilo de vida y autoevaluación de la salud de los colectivos inmigrantes (Álvarez et al 2008), posee un valor comparable de la vida para todos específicamente en la realización y difusión de evaluaciones económicas de la salud para refugiados (Biddle et al 2022). Las normas de género tradicionales pueden restringir la independencia en la migración para las mujeres, impidiéndoles así aprovechar las oportunidades económicas en las zonas urbanas (Amirapu et al 2022).…”