gms | German Medical Science

Background: Owing to a lack of routine statistics and representative studies, there are major knowledge gaps on health status and health care of asylum-seekers and refugees in Germany. A discussion on the future research agenda is necessary in health services research to improve the evidence-base in this area.

Objectives: The aim of this presentation is to synthesise knowledge from empirical studies and highlight important areas for future research from the perspective of primary care and health services research.

Methods: We draw upon a wide range of recent studies, including a systematic review and evidence mapping study, assessments of the German health information system, and a nation wide study on health care among asylum-seekers to meet the above objectives. We synthesise major findings across studies, and illustrate directions for future research.

Results: The majority of empirical research in the last 25 years has studied mental health and infectious diseases, has focussed on burden of disease epidemiology, and has often been detached from health care perspectives. Very few studies have analysed chronic diseases or child health. No studies have analysed health needs/health care of asylum-seeking women during pregnancy and child birth. The majority of studies were characterised by a single sampling-point to recruit asylum-seekers and had limited external validity. A strong divergence between the findings and the heterogeneity of studies hamper the deduction of comprehensive and comparable knowledge.

The routine health information system in Germany has low capacities to generate health- and health-care related information on asylum-seekers - primarily in the areas of micro-data availability, population-based records, chronic diseases and health behaviour. The current practices of health care for asylum-seekers are furthermore characterised by a weak or unclear evidence-base with respect to infectious disease screening, loss of health-related information across sectors, deficient practices of documentation, and a high heterogeneity in health care models.

Discussion: In view of the narrow perspectives of past research, the weaknesses of the routine health information system, and the practical challenges in health care provision for asylum-seekers we identify three major areas for future research: i) establishing reliable estimates on disease burden by means of survey and routine data beyond the narrow spectrum of mental and infectious diseases; ii) assessing effectiveness, quality and efficiency of different health care models by building collaborative research networks; and iii) focusing on vulnerable groups such children, pregnant women, and asylum-seekers with disabilities and severe chronic conditions to improve the equity-impact of research among the heterogeneous group of asylum-seekers.

Practical Implications: The presentation will spark debate about the type of knowledge needed to improve health and health care for asylum-seekers in the future.