ABSTRACT
The Covid-19 Pandemic Policy Monitor (COV-PPM) dataset prospectively documents non-pharmaceutical interventions (NPIs) taken to contain SARS-Cov-2 transmission across countries in EU27, EEA and UK. In Germany, measures have also been recorded at the federal state and, partially, at the district levels. NPIs implemented since January 2020 have been retrieved and updated weekly from March 2020, from official governments webpages, Ministries of Health, National (Public) Health Institutes or Administrations. NPI categories collected refer to restrictions, closures or changes in functioning implemented in 13 domains: public events (gatherings in indoor or outdoor spaces); public institutions (kindergartens, schools, universities); public spaces (shops, bars, restaurants); public transport (trains, buses, trams, metro); citizens movement/mobility (e.g. pedestrians, cars, ships); border closures (air, land or sea, all incoming travels, from high-risk regions, only non-nationals); measures to improve the healthcare system (e.g. human resources or technical reinforcement, redistribution, material or infrastructural); measures for risk/vulnerable groups (e.g. elderly, chronically ill, pregnant); economic measures (e.g. lay-off rules establishment, actions to avoid job-loss, tax relaxation); testing policies (e.g. testing criteria changes); nose and mouth protection rules, vaccination and others/miscellaneous measures.
ABSTRACT
BACKGROUND: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. METHODS: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasi-experiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. RESULTS: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. CONCLUSION: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.
