Comparing refugees\u27 access to health care in the United States and Germany: A systematic review of the literature

The United States and Germany are two developed countries that receive a large number of refugees on an annual basis, yet comparative research is lacking on the experiences of these refugees in terms of their access to health care. This systematic review aims to strengthen the current literature regarding refugees’ access to health care in both countries. The primary objectives of this study were to identify the barriers experienced by refugees accessing health care in the United States and Germany, and to compare the policies related to providing healthcare in both countries. A literature review was conducted on studies published between 2007 to 2016. Key search terms included “refugee + healthcare”, “refugee + healthcare + United States”, “refugee + healthcare + Germany”, “refugee + healthcare + access + Germany”, “refugee + healthcare + United States”, “asylum seekers + health + Germany”, “healthcare + policies + refugees + United States”, “healthcare + policies + refugees + United States”, and “healthcare + barriers + refugees” A total of n=150 studies were identified as relevant and suitable for review. The chosen articles comprised eight cross-sectional studies, one cohort study, one quasi-experimental study, and one interview study. Six of the chosen articles examined refugees’ access to healthcare in the United States. The remaining five articles examined refugees’ access to healthcare in Germany. The literature revealed several recurring and shared barriers to accessing health care in both countries, including language, financial barriers, and lack of health insurance. Additionally, there were country specific barriers according to each country’s respective laws governing healthcare for refugees. Future interventions, programs, and policy changes are inevitably necessary to address these barriers.