title: [Health examination of asylum seekers: A nationwide analysis of state policies in Germany : § 62 of the asylum law].
abstract: BACKGROUND
  A health examination of newly arrived asylum seekers, aimed at detecting infectious diseases and preventing disease outbreaks in accommodation facilities, is mandated by national law in all German states. Due to the decentralized German federal system, different state policies are in place and lead to substantial variation in the content and implementation of the health examination.
  
  
  OBJECTIVE
  To compare health examination policies in the 16 German states with a focus on conducted tests, preventive measures and the general procedure.
  
  
  METHODS
  A comparative content analysis of policy documents addressing the health examination was conducted. Relevant documents were identified through a nationwide search (conducted June-October 2015) through public sources, inquiries at responsible authorities and interviews with representatives of public health services.
  
  
  RESULTS
  In the study period, relevant policy documents for 13 states were identified, of which eight were administrative decrees of the responsible state ministries. Policies differed strongly with respect to the content of the health examination and the selection of compulsory screening measures. We identified three main groups: (A) states with compulsory screening limited to measures enshrined in federal law, (B) states with extended tuberculosis screening for children and pregnant women, and (C) states with extended mandatory screening measures for further infectious diseases beyond tuberculosis. Considerable differences were also found with regard to the implementation of the examinations, and the purchasing and re-imbursement policies.
  
  
  CONCLUSIONS
  The stark heterogeneity in health examination policies between the states cannot be rationally explained from a public health perspective. The indication for certain measures remains unclear. A broad discussion of the medical necessity of screening tests, combined with further systematic analyses, is necessary in order to develop nationwide evidence-based recommendations and decision-making tools for the conduct of health examinations of asylum seekers.
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Wahedi
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Nöst
authors.affiliation: Abteilung Allgemeinmedizin und Versorgungsforschung, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Deutschland. kayvan.bozorgmehr@med.uni-heidelberg.de.
authors.forename: Kayvan
authors.initials: K
authors.lastname: Bozorgmehr
mesh_terms: D004641:Emigration and Immigration / Q000331:legislation & jurisprudence*; D005858:Germany; D033161:Government Regulation; D006291:Health Policy / Q000331:legislation & jurisprudence*; D018580:Mandatory Testing / Q000331:legislation & jurisprudence*; D012036:Refugees / Q000331:legislation & jurisprudence*; D013219:State Government
keywords: Asylum seekers; Health examination; Infection protection; Migration; Screening