Guarantee of illness assistance for people seeking asylum: Two-tiered medical system in Germany?

Abstract

Purpose: In the area of the Asylum Seeker Benefits Act (AsylbLG), there are two options for granting benefits that have practical relevance to health care (depending on the period of previous residence): minimum provision and benefits in special cases, analogous to the Social Code Book XII (SGB XII). Method: This secondary data analysis examines the performance of benefits in the case of illness among benefit recipients according to the AsylbLG at the Research Data Centre of the Federal and State Statistical Offices. The examined group of individuals have not yet been granted refugee status or asylum entitlement. Results: As of 31 December 2018, 423,201 persons in Germany were receiving benefits according to the AsylbLG. A good third of these were women. The average age was 24 years, and more than half came from Asia. More than one-third of all benefit recipients were in outpatient (33.5%) or inpatient treatment (1.3%). Among the federal states, benefits for assistance in the case of illness as well as the health-related per capita gross expenditure varied considerably. The provision of illness benefits in reception facilities was relatively low. With the health card, the use of inpatient treatment was higher. The standard health-related provision of assistance in special cases (§2 AsylbLG analogous to SGB XII) reached a higher share of people entitled to benefits at the end of the year (42.7%) than the minimum provision according to §3 AsylbLG (29.0%). Nevertheless, it caused comparatively less gross expenditure. Conclusion: It is recommended to apply §2 AsylbLG for a prestay period of three months or longer in order to be able to grant assistance analogous to Chapters 5 to 9 SGB XII earlier. Nationwide introduction of an electronic health insurance card for asylum seekers would improve access.