Background: In Germany basic medical care for asylum seekers is organized outside the statutory health insurance system. Currently there are few empirically based statements on how asylum seekers experience their access to healthcare. The aim is therefore to evaluate their experiences with healthcare focussing on subjective health, utilisation and access to medical care, and experiences with medical care. Methods: Between August and November 2015, we performed 16 qualitative problem-oriented guided interviews with asylum seekers, who received or sought medical care in Saxony-Anhalt. The interpreter-assisted interviews were evaluated with content analysis. Results: Access begins with a voucher for medical treatment issued by the social security office. Asylum seekers experience that procedure as onerous and incapacitating. These experiences influence subjective health and utilisation of medical help. If their efforts for treatment certificates are rejected, people increasingly resign. If medical treatment is achieved, they experience medical staff mostly as competent and friendly, in spite of language difficulties and time pressure. Conclusions: Reducing the “voucher bureaucracy” by uniform rules and practices may bring about a relief to access and utilisation of healthcare. Introducing an electronic health insurance card for asylum seekers would retransfer decision making about treatment needs from the welfare system into the medical system. © 2017, Springer-Verlag Berlin Heidelberg.

Asylum seekers Medical services utilisation Healthcare research Voucher for medical treatment Medical services accessibility

Vulnerable Populations vulnerable population communication barrier Germany Communication Barriers refugee health insurance human epidemiology Refugees middle aged statistics and numerical data Aged language interview asylum seeker Young Adult Humans psychology male female Aged, 80 and over social security very elderly welfare patient satisfaction medical service adult human experiment content analysis utilization Utilization Review decision making health literacy medical staff medical care Health Services Accessibility health care delivery Child