<p>Perspectives of Migrants and Employers on the National Insurance Policy (Health Insurance Card Scheme) for Migrants: A Case Study in Ranong, Thailand</p>

Background: In debates on asylum-seekers’ access to healthcare it is frequently claimed that restrictions are necessary to prevent unduly high health service utilization and costs. Within Germany, healthcare provision for asylum-seekers varies across the different states. Berlin’s authorities removed some barriers to healthcare for asylum-seekers by introducing an electronic health insurance card (HIC) in 2016. We used the HIC introduction in Berlin as an opportunity to investigate the effects of improved healthcare access for asylum-seekers on the local health system. Methods: The study applied a mixed-methods design. A cost analysis compared expenses for outpatient and inpatient health services for asylum-seekers before and after the HIC introduction, based on aggregate claims data and information on expenses for humanitarian healthcare provision that were retrieved from the Berlin authorities. Semi-structured interviews with 12 key informants explored organizational effects like administrative workloads and ethical dilemmas for staff. We performed a content analysis and used respondent validation to enhance the accuracy and trustworthiness of our results. Results: The HIC has reduced bureaucratic complexity and administrative workloads; it has enabled unprecedented financial transparency and control; and it has mitigated ethical tensions. All the while, average per person expenses for outpatient health services have declined since the HIC introduction. However, our cost analysis also indicates a rise in the utilization and costs of inpatient care. Conclusion: The HIC introduction in Berlin suggests that the removal of barriers to healthcare for asylum-seekers can create win-win-situations by reducing administrative workloads, advancing financial transparency, and mitigating ethical tensions, whilst cutting the costs of outpatient healthcare provision. Removing barriers to healthcare thus appears to be a more prudent policy choice than maintaining mechanisms of restriction and control. However, high inpatient care utilization and costs warrant further research.

Download Full-text

The Politics of Health Care Reforms in Kenya and their Failure

sozialpolitik ch ◽

10.18753/2297-8224-64 ◽

2016 ◽

Vol 2016 (1) ◽

Author(s):

Daniel Künzler

Keyword(s):

Health Care ◽

Health Insurance ◽

Social Policy ◽

Current Literature ◽

Theoretical Explanation ◽

Policy Reforms ◽

Health Care Reforms ◽

Health Reforms ◽

Free Health Care

The current literature on the politics of social policy has two major shortcomings: health care reforms are undertheoretized and research on Anglophone Africa tends to neglect health reforms. To tackle this, a case study on Kenya presents (failed) re-forms such as universal or categorical free health care or the introduction of health insurance and the expansion of its coverage. The case study clearly shows that there is no single theoretical explanation of social policy reforms or their failure. Rather, there are different combination of factors at work in Kenya.

Download Full-text