scholarly journals Difference in access to health care for newly arrived refugees in Germany: a natural quasi-experiment

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Wenner ◽  
K Rolke ◽  
O Razum
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Access To Health Care ◽  
Emergency Service ◽  
Local Level ◽  
Incidence Rates ◽  
Health Care Use ◽  
Federal State ◽  
Access Barriers ◽  
Access To Health

Abstract Background Providing quantitative evidence on structural access barriers to health care for newly arrived refugees constitutes a challenge due to a lack of suitable data. The coexistence of two different local access models in Germany allows for a comparative analysis of the association between access policies and realized access. Our study compares these two models to establish whether they lead to differences in access to care among refugees. Methods Municipalities in Germany’s largest federal state of North Rhine-Westphalia (NRW) have implemented different access models to which refugees are quasi-randomly assigned. We recruited 6 municipalities of which 3 decided to implement the health care voucher (HcV) model and 3 the electronic health card model (eHC) in a natural quasi-experimental study design. Analyses were based on claims data collected from the welfare offices or the statutory health insurance. We compared standardized incidence rates (SIR) based on 3 indicators: emergency service, ambulatory sensitive hospitalization and use of specialized care. Results We included data on health care use of all recently assigned refugees in the 6 municipalities over a period of 7 quarters (2016/17). The average quarterly sample size is n = 9,077 which corresponds to 6.5% of the population of recently assigned refugees in NRW at that time. We find differences in realized access between the models. For emergency care, the SIR differ significantly between municipalities using the HcV model (SIR:1.88; 95%-CI: 1.62-2.18) and eHC model (SIR:1.33; 95%-CI: 1.14-1.55). Conclusions Local decisions regarding the organization of access to health care are associated with differences in realized access to health care of refugees in NRW. The implementation of the eHC model may contribute to a decrease of emergency service. Further analyses should attempt to reduce a possible (self-)selection bias of municipalities which might have led to an underestimation of the difference between models. Key messages The organization of health care for newly arrived refugees on the local level is decisive for their access to care. Local policy makers may use their scope for action to remove access barriers for newly arrived refugees.

scholarly journals Does the ehealth card facilitate access to healthcare from the point of view of refugees in Germany?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
K Rolke ◽  
J Wenner ◽  
O Razum
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Chronic Illnesses ◽  
Point Of View ◽  
Informal Support ◽  
Federal State ◽  
Health Card ◽  
Delayed Treatment ◽  
Access To Health

Abstract Background The municipalities in the federal state of North Rhine-Westphalia (NRW) decide autonomously how to organize access to health care for refugees: either with electronic health card (eHC model) or with health care voucher (HcV model). The eHC model is often expected to facilitate access to health care and to reduce bureaucratic barriers. However, there are only few analyses of how refugees perceive the two models and their corresponding access to health care. Methods A total of 28 problem-centered interviews with refugees were conducted in three municipalities in NRW (two with HcV and one with eHC model). Sampling was purposive, aiming to achieve a maximum variation of interview partners with regard to age, gender, chronic illnesses, pregnancy and parenthood. The interviews were conducted with the support of translators in the language of the respondents’ choice. Interviews transcripts were evaluated by content analysis using the software atlas.ti. Results Refugees using both the eHC and HcV models report mostly positive experiences when seeking care - both in terms of treatment and interaction with physicians or non-medical staff. The first contact with the health care system was rarely organized by refugees themselves in both models, but mostly with the support of social workers, friends, or family members. The main perceived difference between the models was that in the HcV model, urgent treatment required additional waiting time. Conclusions Access to care is assessed similarly well by refugees in all municipalities. The additional approval process for treatment by the social welfare office in HcV municipalities may lead to a delayed treatment. Formal and informal support is particularly important for newly arriving refugees to help them navigate the complex German health system. Key messages The implementation of one access model alone does not facilitate access to health care for refugees. Formal and informal support is necessary for refugees to gain access to the health system.

scholarly journals Canadian Health Personnel Attitudes Toward Refugee Claimants’ Entitlement to Health Care

2021 ◽  
Author(s):  
Cécile Rousseau ◽  
Joanna Anneke Rummens ◽  
Rochelle L. Frounfelker ◽  
Monica Ruiz Casares Yebenes ◽  
Janet Cleveland
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Vulnerable Populations ◽  
Access To Health Care ◽  
Health Care Personnel ◽  
System Level ◽  
Equal Access ◽  
Access To Health ◽  
Refugee Claimants ◽  
Canadian Health

AbstractHealth care personnel attitudes toward refugee claimant entitlement to health care are influenced by multilevel factors including institutional and societal culture. Although individual attitudes may be modified through training, macro- and meso-issues require system-level interventions. This paper analyzes the role of individual-, institutional-, and city-level factors in shaping attitudes toward refugee claimants’ access to health care among Canadian health care personnel. A total of 4207 health care personnel in 16 institutions located in Montreal and Toronto completed an online survey on attitudes regarding health care access for refugee claimants. We used multilevel logistic regression analysis to identify individual-, institutional-, and city-level predictors of endorsing access to care. Participants who had prior contact with refugee claimants had greater odds of endorsing access to care than those who did not (OR 1.13; 95% CI 1.05, 1.21). Attitudes varied with occupation: social workers had the highest probability of endorsing equal access to health care (.83; 95% CI .77, .89) followed by physicians (.77; 95% CI .71, .82). An estimated 7.97% of the individual variation in endorsement of equal access to health care was attributable to differences between institutions, but this association was no longer statistically significant after adjusting for city residence. Results indicate that the contexts in which health care professionals live and work are important when understanding opinions on access to health care for vulnerable populations. They suggest that institutional interventions promoting a collective mission to care for vulnerable populations may improve access to health care for precarious status migrants.

scholarly journals Access to health care for patients with thalassaemia in Greece: a cross-sectional study

2020 ◽  
Vol 26 (12) ◽  
pp. 1482-1492
Author(s):  
Kyriakos Souliotis ◽  
Christina Golna ◽  
Sofia Nikolaidi ◽  
Georgia Vatheia
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Access To Health Care ◽  
Cross Sectional Study ◽  
Social Needs ◽  
Sectional Study ◽  
Outpatient Services ◽  
Cross Sectional ◽  
Beta Thalassaemia ◽  
Access To Health

Background: The prevalence and clinical burden of beta-thalassaemia in Greece is high. Little information is available on the unmet needs of patients with beta-thalassaemia and barriers to access to care. Aims: This study investigated barriers that patients with transfusion-dependent beta-thalassaemia in Greece face when accessing care and the associations between socioeconomic factors and access to care. Methods: A cross-sectional study was conducted between November 2018 and January 2019. The sample consisted of 116 beta-thalassaemia patient-members of two Panhellenic patient associations for people with thalassaemia. All respondents were transfusion-dependent. The survey customized and used the Patient Access Partnership 5As of access tool to measure participants’ access to health care services (subscales: accessibility, adequacy, affordability, appropriateness and availability). Data on their socioeconomic characteristics were also recorded. The association between the total score of each subscale and patient characteristics was examined using the Mann–Whitney or Kruskal–Wallis tests. Results: Respondents considered inpatient services less adequate and appropriate, and outpatient services and laboratory tests less affordable. Outpatient services were also perceived as less available. Participants’ income was statistically significantly associated with all the subscales except accessibility, and rural residence was significantly associated with all five subscales. Conclusion: Barriers in access to health care among beta-thalassaemia patients receiving transfusions still persist, especially for those who live far from transfusion centres and have lower incomes. It is important to understand and map current unmet medical and social needs of beta-thalassaemia patients in Greece, in order to design and implement a targeted health policy that can measurably improve patients’ lives.

scholarly journals Intersection of Migration and Access to Health Care: Experiences and Perceptions of Female Economic Migrants in Canada

2020 ◽  
Vol 17 (10) ◽  
pp. 3682
Author(s):  
Solina Richter ◽  
Helen Vallianatos ◽  
Jacqueline Green ◽  
Chioma Obuekwe
Keyword(s):  
South Africa ◽  
Health Care ◽  
Access To Care ◽  
Health Care System ◽  
Access To Health Care ◽  
Social Connectedness ◽  
Reproductive Age ◽  
African Countries ◽  
Access To Health ◽  
Care System

More people are migrating than ever before. There are an estimated 1 billion migrants globally—of whom, 258 million are international migrants and 763 million are internal migrants. Almost half of these migrants are women, and most are of reproductive age. Female migration has increased. The socioeconomic contexts of women migrants need investigation to better understand how migration intersects with accessing health care. We employed a focused ethnography design. We recruited 29 women from three African countries: Ghana, Nigeria, and South Africa. We used purposive and convenient sampling techniques and collected data using face-to-face interviews. Interviews were audio-recorded and transcribed verbatim. Data were analyzed with the support of ATLAS.ti 8 Windows (ATLAS.ti Scientific Software Development GmbH), a computer-based qualitative software for data management. We interviewed 10 women from both South Africa and Ghana and nine women from Nigeria. Their ages ranged between 24 and 64 years. The four themes that developed included social connectedness to navigate access to care, the influence of place of origin on access to care, experiences of financial accessibility, and historical and cultural orientation to accessing health care. It was clear that theses factors affected economic migrant women’s access to health care after migration. Canada has a universal health care system but multiple research studies have documented that migrants have significant barriers to accessing health care. Most migrants indeed arrive in Canada from a health care system that is very different than their country of origin. Access to health care is one of the most important social determinants of health.

scholarly journals Perceptions of Health Care Use in Germany during the COVID-19 Pandemic

2020 ◽  
Vol 17 (24) ◽  
pp. 9351
Author(s):  
André Hajek ◽  
Freia De Bock ◽  
Lothar H. Wieler ◽  
Philipp Sprengholz ◽  
Benedikt Kretzler ◽  
...  
Keyword(s):  
Health Care ◽  
Regression Analysis ◽  
Medical Care ◽  
Access To Health Care ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Health Care Use ◽  
Access To Health ◽  
Using Data ◽  
Perceived Access

This paper examined the determinants of perceived access to health care use during the COVID-19 pandemic in Germany using data from two waves (8 and 16) of the COVID-19 Snapshot Monitoring (COSMO). Descriptive and regression analysis were used. In wave 8, we found that about 60% of the individuals rather disagreed about having had problems accessing medical care. Furthermore, 73% of the individuals rather disagreed to having experienced health deteriorations due to restrictions on the availability of medical care. Moreover, 85% of the individuals were rather optimistic about future access to healthcare services. Overall, slightly better past and future access to healthcare services has been reported in wave 16. Several determinants were identified in regression analysis. In conclusion, data suggest that perceived past and future access to healthcare services during the COVID-19 pandemic is reasonably good.

scholarly journals Access to health care among people with foreign background and the general population in Finland

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H Kuusio ◽  
A Seppänen ◽  
E Lilja ◽  
T Vehko ◽  
S Jokela ◽  
...  
Keyword(s):  
Health Care ◽  
General Population ◽  
Access To Care ◽  
Marital Status ◽  
Access To Health Care ◽  
Language Skills ◽  
Perceived Health ◽  
Access To Health ◽  
Perceived Access

Abstract Background Prior studies suggest that people with foreign background (PFB) often face problems in access to health care, although access to care may vary between the different PFB groups. This study explores 1) the potential differences in perceived access to care between different PFB groups and the general population, and 2) if marital status, education, employment, self-perceived health, long-term illness, length of stay, age moved to Finland or language skills are associated with access to care among PFB. Methods The data were gathered from the cross-sectional survey on well-being among the PFB (FinMONIK), conducted in Finland 2018. Its random sample consisted of 12 877 persons, aged 18-64 years and the response rate was 53%. Three items were used to assess perceived access to care: I was able to contact the place of care smoothly, I was able to make an appointment without undue delay and I was examined without undue delay (e.g. laboratory tests, X-ray, ultrasound). Logistic regression was used to test which factors were associated with accesses to care, adjusted for age, sex and region. Results After controlling for age, sex and region, the results showed significant differences in access to care among different migrant groups and the general population (p < 0.001). Of those of Estonian background 37% felt that access to care was smooth while only 17% of those coming from Middle-East, and 26% of the general population. Employed persons, persons who had good self-perceived health, and people with no long-term illness, and those who had lived in Finland less than five years, had better access to health care. Marital status, education, language skills and age moved to Finland, were not associated with access to care. Conclusions Large inequities in access to care were identified among people with foreign background. Access to services seems to be better for employed persons and those who have good self-perceived health. Key messages Special attention should be given to improve access to care among non-employed migrants. Migrants should not be considered as a uniform group when planning services.

Health, Access to Health Care, and Health Care use Among Homeless Women with a History of Intimate Partner Violence

2011 ◽  
Vol 37 (5) ◽  
pp. 1032-1039 ◽  
Author(s):  
Maya Vijayaraghavan ◽  
Ana Tochterman ◽  
Eustace Hsu ◽  
Karen Johnson ◽  
Sue Marcus ◽  
...  
Keyword(s):  
Health Care ◽  
Intimate Partner Violence ◽  
Partner Violence ◽  
Access To Health Care ◽  
Intimate Partner ◽  
Health Care Use ◽  
Homeless Women ◽  
Health Access ◽  
Access To Health ◽  
History Of

scholarly journals Disparities in Access to Care and Satisfaction among U.S. Children: The Roles of Race/Ethnicity and Poverty Status

2005 ◽  
Vol 120 (4) ◽  
pp. 431-441 ◽  
Author(s):  
Leiyu Shi ◽  
Gregory D. Stevens
Keyword(s):  
Health Care ◽  
Access To Care ◽  
Medical Care ◽  
Access To Health Care ◽  
Ethnic Disparities ◽  
Access To Health ◽  
Poverty Status ◽  
Quality Of Medical Care ◽  
Race Ethnicity ◽  
Racial Ethnic

Objectives. The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. Methods. Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. Results. Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. Conclusions. Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.

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