Welche gesundheitsbezogenen Informationen brauchen Geflüchtete?: Eine Mixed-methods-Studie aus Sicht von Versorgenden und Geflüchteten

Exploring how Syrian women manage their health after migration to Germany: results of a qualitative study

BACKGROUND

In the recent years, the number of Syrians living in Germany increased drastically due to the massive displacement caused by the Syrian conflict. Syrian migrant women in Germany are challenged by both the migration process and the changing of social roles. Seeking out healthcare may be hampered by linguistic and cultural barriers, but the new context may offer opportunities for health and well-being (free access to health care, civil/human rights). Little is known about how Syrian women manage their health after their resettlement in Germany.

METHODS

In depth interviews in Arabic were conducted with 9 Syrian women who were recruited through purposive sampling (18-55 years, migrated in 2011-2017, different education levels), focusing on capabilities to control one's health and to navigate the German healthcare system, and social/environmental barriers and facilitators to effectively manage their health. Interview transcripts were analysed using qualitative content analysis.

RESULTS

The women reported their health to be impaired by post-migration stressors, such as perceived discrimination, loss of social status and worrying about the future. Many interviewees felt disempowered and incompetent to successfully and actively navigate the German healthcare system, lacking information and not understanding their rights and options under the health insurance plan. The language barrier added to feeling vulnerable. Many women experienced doctors declining to treat them for capacity reasons; when treated, they often did not feel taken seriously or were dissatisfied with the emotional/cultural aspects of care. If possible, Arabic doctors were sought out. Some women, however, described improved resources for health, and appreciated better women's rights as a source of power.

CONCLUSIONS

The lack of information about the structure and offers of the German healthcare system, language and culture specific barriers as well as socio-cultural challenges are undermining the ability of Syrian women to manage their health effectively after their resettlement in Germany. Providing tailored information on the German healthcare system, creating a health-literacy supportive environment, and improving cultural sensitivity in healthcare provision could help Syrian women better utilize medical care offered in Germany.

Outpatient health care utilization and health expenditures of asylum seekers in Halle (Saale), Germany - an analysis of claims data

Background

Asylum seekers are a vulnerable group with special needs in health care due to their migration history and pre-, peri- and postmigratory social determinants of health. However, in Germany access to health care is restricted for asylum seekers by law and administrative regulations.

Methods

Using claims data generated in the billing process of health care services provided to asylum seekers, we explore their utilization of health care services in the outpatient sector. We describe the utilization of outpatient specialties, prevalences of diagnoses, prescribed drugs and other health care services, as well as total costs of health care provision.

Results

The estimated prevalence for visiting an ambulatory physician at least once per year was 67.5% [95%-Confidence-Interval (CI): 65.1–69.9%], with a notably higher prevalence for women than men. The diagnoses with the highest one-year prevalence were “Acute upper respiratory infections” (16.1% [14.5–18.0%]), “Abdominal and pelvic pain” (15.6% [13.9–17.4%]) and “Dorsalgia” (13.8% [12.2–15.5%]). A total of 21% of all prescriptions were for common pain killers. Women received more diagnoses across most diagnosis groups and prescribed drugs from all types than men. Less than half (45.3%) of all health care costs were generated in the outpatient sector.

Conclusion

The analysis of claims data held in a municipal social services office is a novel approach to gain better insight into asylum seekers’ utilization of health services on an individual level. Compared to regularly insured patients, four characteristics in health care utilization by asylum seekers were identified: low utilization of ambulatory physicians; a gender gap in almost all services, with higher utilization by women; frequent prescription of pain killers; and a low proportion of overall health care costs generated in the outpatient sector. Further research is needed to describe structural and individual factors producing these anomalies.

„Da muss sich jemand anders kümmern“ – Die medizinische Versorgung von Asylsuchenden als Herausforderung für eine bio-psycho-soziale Medizin

Ziel der Studie Die Medizin wird verschiedentlich dafür kritisiert, die biologischen Facetten von Gesundheit und Krankheit gegenüber gesellschaftlichen Einflüssen zu privilegieren. Gegen diesen Vorwurf hat sich in den letzten Jahrzehnten ein medizintheoretischer Ansatz etabliert, der ein bio-psycho-soziales Krankheitskonzept vertritt. Dieser Artikel nutzt ethnografische Perspektiven auf die medizinische Versorgung von Asylsuchenden, um zu untersuchen, inwiefern die Prinzipien der bio-psycho-sozialen Medizin in Bezug auf die wissenschaftlich fundierte Berücksichtigung gesellschaftlicher Einflüsse auf die Gesundheit und Krankheit dieser Patientengruppe verwirklicht werden.

Methoden Dabei findet ein ethnografisches Methodenrepertoire mit narrativen Interviews, Leitfadeninterviews und teilnehmender Beobachtung Anwendung.

Ergebnisse Anhand des Umgangs mit den rechtlichen Rahmenbedingungen der medizinischen Versorgung von Asylsuchenden und mit Sprachinkongruenz wird gezeigt, dass es Ärzt/-innen regelmäßig nicht gelingt, die gesundheitsbezogene Lebenswelt dieser Patientengruppe adäquat und wissenschaftlichen Standards entsprechend in Diagnostik und Therapie zu berücksichtigen. Stattdessen rekurrieren sie im klinischen Alltag häufig auf improvisierte Lösungsansätze oder verschieben die Verantwortung auf andere, oft unbenannte Akteure.

Schlussfolgerung Sozialwissenschaftliche Ansätze, v. a. aus der Medizinanthropologie, könnten diese zu Versorgungsdefiziten führenden Schwierigkeiten beheben und sollten daher vermehrt in die ärztliche Aus- und Weiterbildung integriert werden. Dadurch könnten zudem theoretische und methodische Lücken geschlossen werden, die möglicherweise auch in der Versorgung anderer Patientengruppen bedeutsam sind.