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Inequalities in realised access to healthcare among recently arrived refugees depending on local access model: study protocol for a quasi-experimental study
  1. Judith Wenner1,
  2. Kristin Rolke1,
  3. Jürgen Breckenkamp1,
  4. Odile Sauzet1,
  5. Kayvan Bozorgmehr2,3,
  6. Oliver Razum1
  1. 1 Department of Epidemiology and International Public Health, Bielefeld School of Public Health, Bielefeld, Germany
  2. 2 Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
  3. 3 Department of Population Medicine and Health Services Research, Bielefeld School of Public Health, Bielefeld, Germany
  1. Correspondence to Judith Wenner; judith.wenner{at}


Introduction In many countries, including Germany, newly arriving refugees face specific entitlement restrictions and access barriers to healthcare. While entitlement restrictions apply to all refugees who seek protection in Germany during the first months, the barriers to access depend on the model that the states and the municipalities implement locally. Currently, two different models exist: the healthcare voucher model (HcV) and the electronic health card model (eHC). The aim of the study is to analyse the consequences of these two different access models on newly arrived refugees’ realised access to healthcare.

Methods and analysis The random assignment of refugees to municipalities allows for a quasi-experimental design by comparing realised access to healthcare among refugees in six municipalities in North Rhine-Westphalia which have implemented HcV or eHC. We compare realised access to healthcare using ambulatory care sensitive conditions and health expenditure as outcome indicators, and use of emergency care, preventive care, psychotherapeutic or psychiatric care, and of therapeutic devices as process indicators. Results will be adjusted for aggregated information on age, sex, socioeconomic structure of the municipalities and density of general practitioners or specialists.

Ethics and dissemination We cooperated with local welfare offices and the statutory health insurance for data collection. Thereby, we were able to avoid recruiting large numbers of refugee patients immediately after arrival while their access and entitlement to healthcare are restricted. We developed an extensive data protection concept and ensured that all data collected are fully anonymised. Results will be published in peer-reviewed journals and summarised in reports to the funding agency.

  • refugee health
  • access to health care
  • quasi-experimental design
  • health policy
  • organisation of health services
  • public health

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  • Contributors JW, KR und OR designed the study. JB, OS und KB made substantial contributions to its conception and design. JW drafted the manuscript. KR, JB, OS, KB und OR revised the manuscript critically for important intellectual content. All authors read and approved the final manuscript.

  • Funding The work was supported by the Ministry of Culture and Research of the Federal State of North Rhine-Westphalia (grant number 1704i010). We acknowledge the financial support of the German Research Foundation (DFG) and the Open Access Publication Fund of Bielefeld University for the article processing charge.

  • Competing interests None declared.

  • Ethics approval The study has been positively reviewed by the Ethics Committee and the data protection officer of Bielefeld University (application no 2017–099, 10 May 2017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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