Should Germany introduce a refugee health card?

Since over one million refugees came to Germany in 2015 there has been much debate around how best to provide health care for the new arrivals. In the absence of one unified approach, Germany’s federal system has given rise to a number of experiments as each state and town pursues its own policies. The latest proposal to seek emulation comes from Thorsten Krüger, mayor of Geestland, a small town in Northern Germany. His solution: A so-called refugee identification card.

Krüger and his staff developed the card together with Ordermed, a private software company in the region. The card is meant to incur only half of the administration costs that state health insurance cards currently carry. “Our goal is to accelerate the integration process among refugees,” Krüger says. He goes on to argue that the proposed system eliminates several bureaucratic steps that other invoicing mechanism might include. The refugee card also doubles as a means of identification and contains information about the individual’s pre-existing conditions and inoculation history.

In other city states like Bremen and Hamburg refugees are currently issued with full state health insurance cards that give them the same cover as 86 percent of the German population. Getting sick in states like Lower Saxony on the other hand involves more of a bureaucratic gamut. In lieu of cards refugees have to get a Behandlungsschein (treatment waiver) that allows them to see a doctor. The cost of consultation is then settled through a complicated network of intermediaries. In all cases the local municipality eventually foots the bill.

“We have no malicious intentions in developing this system,” Krüger says. The 50 year old mayor comes across as somewhat defensive as he preemptively knocks down any objections. The refugee identification card has come under fire because it essentially would provide partial cover to asylum seekers. Under the current formulation patients would get full emergency care, while receiving restricted access to some dental procedures and other non-essential health provisions. “If we had to offer full coverage from the first day onwards, we would be creating false incentives,” Krüger says. “It’s better to start small.”

A report by the president of the German Medical Association, Frank Ulrich Montgomery, suggests the concerns about false incentives might have been overstated. Montgomery says refugees tend to be “extra healthy individuals” given that the current refugee cohort is comprised mostly of young men. He told the Welt newspaper that the average costs associated with asylum seekers amount to 2,300 Euros; 600 Euros less than for the average German. Montgomery went on to say that refugees were also open to being inoculated and pointed out that very few chronically ill patients make it to the country.

As it stands Krüger’s proposal has been met with indifference among other municipalities. His team has sent hundreds of letters to health ministries around the nation, touting the benefits of the system. To date he has received no reply.

Frank Lindscheid, media liaison for the health ministry in Kiel has told the media that the refugee card cannot provide the level of care that is currently possible with state health insurance. Lindscheid also says the benefits to integration offered by the state card cannot be achieved using the proposed system.

Although some ministries are looking for alternatives to the cumbersome Behandlungsschein system, the refugee identification card seems unlikely to be the hoped-for replacement. For now the consensus about Thorsten Krüger’s solution is as unanimous as it is damning.


T L Andrews


TL Andrews is a multi-media journalist based in Berlin. He produces features for radio, television and print outlets with a focus on German and European issues.

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