title: [Hospitalization of Migrants without Health Insurance: An Explorative Study of Hospital Healthcare in Lower Saxony, Berlin and Hamburg].
abstract: BACKGROUND
  Different reasons prevent migrants from obtaining health insurance resulting in their exclusion from regular medical care in Germany. In case of medical emergency, hospitals are obliged by law to provide treatment. In addition, hospitals might get reimbursed for treatment expenses by social welfare authorities. This includes undocumented migrants who should not be reported to the police. However, actual legislation regarding the level of medical intervention, the principles of medical confidentiality and the conditions of reimbursement by the authorities is unclear. Thus, migrants without health insurance may be precluded from receiving urgent medical treatment.
  
  
  OBJECTIVE
  A first assessment of hospital health care for migrants without health insurance in three federal states with the intention to identify obstacles in access to in- and out-patient emergency treatment.
  
  
  METHODS
  Electronic mail survey of all non-specialized general hospitals located in the federal states of Niedersachsen (Lower Saxony, n=129), Berlin (n=46) and Hamburg (n=24). Data was anonymized and descriptively analyzed using SPSS statistical software.
  
  
  RESULTS
  Rate of questionnaire return was 31.2% (n=62). Almost all hospitals had already encountered migrants without health insurance in their emergency wards (82.3%) including 72.5% undocumented migrants. 76.7% of all hospitals had submitted a subsequent emergency aid proposal to the social welfare authorities. 17.1% of them confirmed that they were reimbursed in most cases. 8.5% of all participating hospitals mostly consult the police in case migrants are not able to provide any means of identification, whereas 43.6% consult the police only in rare cases. 64.5% of all hospitals reported non-reimbursed expenses for 2011 - 2014 ranging from € 4 000 - €1.01 million.
  
  
  CONCLUSIONS
  RESULTS indicate that the provision of care for people without health care insurance represents an important issue for a majority of the assessed hospitals since they have to take the responsibility for treatment costs in many cases. Moreover, the term "medical emergency" can be differently interpreted. Due to the inconsistent processing of cases and confusing legislation, a low-threshold health care access for (undocumented) migrants is not available. The actual legal system may result in disease progression because of uncertainty on the part of hospitals and migrants; it is also inadequate in case of emergency.
authors.affiliation: Professur für Ethik in der Medizin, Institut für Geschichte und Ethik der Medizin, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen.
authors.forename: M
authors.initials: M
authors.lastname: Mylius
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy / Q000706:statistics & numerical data; D015995:Prevalence; D016079:Refusal to Treat / Q000706:statistics & numerical data; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult