Restrictions to access to healthcare through governmental Duties to Report for people without legal residence status

Legal Basis

Die gesetzlich vorgesehene Gesundheitsversorgung ist auch für Menschen ohne rechtlichen Aufenthaltsstatus im Asylbewerberleistungsgesetz festgelegt. Der Leistungsanspruch ergibt sich aus § 1 Abs. 1 Nr. 5 i.V.m. §§ 4 und 6 AsylbLG. Darin wird Menschen ohne rechtlichen Aufenthaltsstatus – wie allen Menschen, für die das AsylbLG gilt – eine eingeschränkte medizinische Versorgung zugesprochen. (vgl. Text §§ 4, 6 AsylbLG)

What does Duty to Report mean?

In order to claim health benefits, patients need to personally apply at the relevant social welfare authority for a healthcare voucher or, in some federal states, for an electronic Health Card. For persons without legal residence status the difficulties in exercising their rights are due to the reporting duties of public bodies, including all authorities such as social welfare offices, with the exception of hospitals. Hospital staff, medical as well as administrative staff, have no Duties to report – nor rights – to notify the police or the immigration authority about the irregular residence status of their patients (Clarification through the General Administrative Regulation to the Right of Residence 2009).
Contrary to this, the instruction directed at all other public bodies, stipulated in § 87 para. 2 Residence Act, to »immediately inform the relevant immigration office«, if they become aware of persons without legal residence status, constitutes the main barrier that hinders access to healthcare. This is why this path, mandated by law for application and the subsequent payment of costs (via the healthcare voucher) through the social welfare office, is not being pursued by persons without legal residence status. ¹

Consequences of the law on migrants

For people with no legal residence status the danger of being exposed is an existential problem, which in most cases prevents them seeking medical attention. People weigh up which threat is greater: impending deportation or detention on the one hand, or the danger of the disease on the other hand. Usually those affected only go to a doctor when the disease-related problems are so grave that they impede considerably on their daily work or have reached life-threatening dimensions. ² This leads to disease not being recognized, or too late, and being treated inadequately or not at all. If left and treated too late, conditions can cause cost-intensive emergency hospital treatments and have serious long-term health effects. ³

Medi-networks, Medicare offices, Medical Refugee Relief

In order to counter this shortage, a “temporary” ⁴ developed out of the work conducted between civil society and the medical community soon after the first restrictions were placed on the right to asylum in 1993.

⁵These solidarity networks are known as ⁶ and are run on a voluntary basis through donations. ⁷They are self-organized institutions that provide a restricted level of spatially limited health care and are focused on finding people places in conventional medical practices. These then provide the necessary treatment free of charge, meaning that healthcare is often provided in an outpatient setting. These institutions face difficulties when hospital treatment is required due to the high costs involved. Moreover, hospitals often only provide refugees with provisional emergency care so as to ensure that social services will cover the costs. In some cases, hospitals may even deny provisional emergency care or even call the police to help identify the person in need of care. This can have serious consequences for the person in question.
87 Abs. 2 Residency Act