Health Status and Access to Healthcare for Uninsured Migrants in Germany: A Qualitative Study on the Involvement of Public Authorities in Nine Cities

Abstract

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.

Healthcare for individuals without health insurance in Germany – a mixed methods approach to assess the situation and current challenges

“…It was common practice in LPHAs (Local public health agencies) to refer cases with unresolved financial or legal challenges and medical problems to NGOs and physicians who provide pro bono or reduced-paid services [ 29 ]. However, voluntary associations could not provide care at an adequate standard.…”

Prevalence, characteristics and challenges of late HIV diagnosis in Germany: an expert narrative review

“…In addition, migrants without health insurance were less likely to have ever received an HIV test compared with participants with health insurance (adjusted OR 0.55; 95% CI: 0.31–0.95; p = 0.033) [ 63 ]. In a qualitative study across nine German cities, 12 experts from local and state-level public health authorities and social security offices were interviewed (between July 2017 and January 2018) to assess their work with uninsured migrants [ 64 ]. The main challenge reported for chronic diseases (HIV, hepatitis and diabetes) was the cost associated with regular diagnostics and medications, making the provision of healthcare to uninsured migrants particularly challenging.…”