Shaping access to health care for refugees at the local level in Germany

Background In Germany, the federal states and even the municipalities have considerable scope for shaping implementation of national health policies for newly arrived refugees, including in the way they organize access to health services. We analysed how gatekeepers can shape access to health care at the local level, exploring access models in six municipalities in the federal state of North Rhine-Westphalia. Methods We assessed the implementation of local access models and the consequences for access for refugees. Our study covered three municipalities with a health care voucher model and three with an electronic health card model. We combined data from official reports and from 21 semi-structured interviews with gatekeepers. Results Our research illustrates how gatekeepers at the local level can shape and facilitate access to health care for refugees, irrespective of the access model chosen. Larger municipalities are more likely to implement an electronic health card model. Gatekeepers report that costs, workload and control are the major aspects underlying the choice of model in municipalities. Access plays only a minor role, although some gatekeepers claim that the electronic health card model can improve access. Conclusions National health policies can support gatekeepers in their role as facilitators, such as through financial incentives or a minimum amount of bureaucracy. They can also allow newly arrived refugees to become members of the statutory health insurance system, which would relieve social welfare offices and general practitioners (GPs) from their role of gatekeepers.

Investigating Doctor Views on E-Health Cards

Computing is a powerful health resource that contributes to the improved quality of health services provided by medical units. This study aimed to investigate Greek physicians' views on the electronic health card. Between February 2019 to April 2019, 116 physicians from three hospitals in the broad area of Athens completed a self-administered questionnaire related to the use of the Internet, the electronic health card, and information technology in health. The results were analyzed with IBM SPSS 23.0. A positive assessment of the model in terms of its potential public health benefits was found. Obstacles to the management of health information systems and the high cost must be taken into account. The smart card is a possible channel for improving the quality of the services provided, making significant progress in the units of the national health system but the implementation cost and the ways of managing it must also be taken into consideration.