[Hospitalization of Migrants without Health Insurance: An Explorative Study of Hospital Healthcare in Lower Saxony, Berlin and Hamburg]. / Krankenhausaufenthalte von Migrantinnen und Migranten ohne Krankenversicherung - Eine explorative Studie zur stationären Versorgung in Niedersachsen, Berlin und Hamburg.

BACKGROUND: Different reasons prevent migrants from obtaining health insurance resulting in their exclusion from regular medical care in Germany. In case of medical emergency, hospitals are obliged by law to provide treatment. In addition, hospitals might get reimbursed for treatment expenses by social welfare authorities. This includes undocumented migrants who should not be reported to the police. However, actual legislation regarding the level of medical intervention, the principles of medical confidentiality and the conditions of reimbursement by the authorities is unclear. Thus, migrants without health insurance may be precluded from receiving urgent medical treatment. OBJECTIVE: A first assessment of hospital health care for migrants without health insurance in three federal states with the intention to identify obstacles in access to in- and out-patient emergency treatment. METHODS: Electronic mail survey of all non-specialized general hospitals located in the federal states of Niedersachsen (Lower Saxony, n=129), Berlin (n=46) and Hamburg (n=24). Data was anonymized and descriptively analyzed using SPSS statistical software. RESULTS: Rate of questionnaire return was 31.2% (n=62). Almost all hospitals had already encountered migrants without health insurance in their emergency wards (82.3%) including 72.5% undocumented migrants. 76.7% of all hospitals had submitted a subsequent emergency aid proposal to the social welfare authorities. 17.1% of them confirmed that they were reimbursed in most cases. 8.5% of all participating hospitals mostly consult the police in case migrants are not able to provide any means of identification, whereas 43.6% consult the police only in rare cases. 64.5% of all hospitals reported non-reimbursed expenses for 2011 - 2014 ranging from € 4 000 - €1.01 million. CONCLUSIONS: RESULTS indicate that the provision of care for people without health care insurance represents an important issue for a majority of the assessed hospitals since they have to take the responsibility for treatment costs in many cases. Moreover, the term "medical emergency" can be differently interpreted. Due to the inconsistent processing of cases and confusing legislation, a low-threshold health care access for (undocumented) migrants is not available. The actual legal system may result in disease progression because of uncertainty on the part of hospitals and migrants; it is also inadequate in case of emergency.

[Health care for undocumented migrants--a quantitative study on the role of local health authorities in Germany]. / Medizinische Versorgung von Migrantinnen und Migranten ohne legalen Aufenthaltsstatus--Eine Studie zur Rolle der Gesundheitsämter in Deutschland.

Public welfare on a municipal level for groups with special health risks has been an important topic of public health service for more than a century. This notion has been taken up by the German "Protection against Infection Act" (IfSG) in § 19 IfSG. Local health service authorities may provide out-patient treatment in addition to counselling and diagnosis for patients with sexually transmitted infections and tuberculosis, which is covered by public resources in cases of apparent need. Due to altered legislation and increased global mobility, this may become important for migrants without access to regular health care.Aims of this study were recording, counselling, diagnosis and out-patient treatment of migrants without legal residence status under the German Protection against Infection Act in the public health care system.An electronic mail survey of all local health authorities (n=384) by means of a standardised questionnaire was undertaken. Data were analysed using descriptive statistics. In the annex of the questionnaire the participants were asked to describe a case study.139 of 384 local health authorities completed the questionnaire (36.2%) of whom approximately a quarter (24.6%) described contacts to "illegal" migrants. Contacts to migrants without legal residence status are more frequent in cities with more than 100,000 inhabitants than in ismaller cities (p<0.05). 22.6% of all local health authorities make an effort to reach undocumented migrants for counseling and diagnosis. 25 of the local health authorities (18.4%) indicated the capability to provide treatment in accordance with § 19 IfSG. A majority of these local health authorities also have contacts to undocumented migrants (75%). 16 local health authorities (13.3%) provide out-patient treatment for diseases not listed in Protection against Infection Act. 56 authorities (46.7%) refer patients to aid organisations or to resident doctors.Only a small number of local health authorities have contacts to migrants without health insurance. The option-al out-patient treatment is provided by few local health authorities especially in cases of sexual transmitted diseases except for HIV/AIDS. In most cases undocumented migrants are only one group among others. The large number of cases in cities with more than 500,000 inhabitants shows the massive requirements.