Immigrant Care in Germany

About one in five Germans is an immigrant, according to census data from the German Federal Statistics Department.  In fact, Germany is the second most popular migration destination in the world, after the United States. I would argue that this is one of the reasons that Germany is the most dominant economy in Europe. 

Here in St. Louis, the Mosaic Project collected data which show a compelling link between the percentage of foreign-born people in a given region and that region’s economic vitality. There is every reason to believe that the same phenomenon applies in Germany.  In fact, when it comes to healthcare, immigrants may be net financial contributors of health services if they pay proportionately more in taxes, as well as provide the otherwise scarce labor to staff health services. Data show that around 12% of all health service workers in Germany are immigrants.  Also, there is evidence that new immigrants to a country are typically healthier than the native-born population, thereby creating a “health dividend” for the receiving country (increase in labor supply that uses healthcare resources less and stays on the job more).

Of course, any such benefits can wane over time if, as often happens, immigrant populations start taking on the unhealthy habits of the native-born population and if the immigrants are denied access to care.  Germany has moved to avoid falling into this cycle by allowing undocumented immigrants to gain access to affordable care in case of acute illness and pain, as well as pregnancy and childbirth. The country also provides health insurance to any legally registered immigrant. 

Still, the risk of accidents at work among adults is twice as high for migrants than the native-born, and working conditions that threaten health are experienced disproportionately by semi-skilled and unskilled workers. These types of workers are over-represented among all migrant sub-groups.  Also, industrial accidents have tended to be higher among migrants working with poor safety measures.

Questions of interest for me while in Germany will include how the country finances care for, as Germans term them, “irregular” members of the society and what factors led to the political will to be able to provide the care. Also, how well have immigrants been integrated into the overall system?  Are there cultural competency issues?   Are there issues endemic primarily to immigrant populations that remain vexing? 

All of these are compelling questions for us in the U.S. The ability to care for people with market-based solutions and, perhaps more-so, the overcoming of ideological objections, are the largest obstacles to long-term healthcare reform (of which the ACA, I believe, is only a first step). Is there something from the German experience that might be instructive?  The Germans are also having to deal with cultural differences, for example treating a Turkish - mostly Muslim - population. How are they dealing with the issue of providing culturally competent care, something that is challenging for us in America? 

What questions would you, the reader, want answered?