Table 1.
Determinants of healthcare utilisation according to Andersen18
| Explanation and concretisation (adapted from ref 18) |
Availability of information | |
| Predisposing characteristics | ||
| Demographics | Age and sex. | Aggregated data available for all municipalities; individual-level data only available from municipalities with eHC. |
| Social structure | Socioeconomic status and origin/nationality. | Not available. |
| Health beliefs | Attitudes, values and knowledge about health or health services. | Not available. |
| Enabling resources | ||
| Individual/Family | Financial means and health insurances. | Not available; entitlements to benefits according to AsylbLG are need-based, and thus these regulations apply only to people whose financial means are generally limited and who do not have a valid health insurance in Germany (Article 7 of AsylbLG). |
| Community | Availability of health personnel and facilities, travel and waiting time. | Limited availability: density of general practitioners and specialised doctors.40 41 |
| Social relationships | Social support. | Not available. |
| Need | ||
| Perceived need | Subjective health. | Not available. |
| Evaluated need | Professional judgements about healthcare needs (eg, diagnoses). | Only available for those who actually used healthcare and even among those who used healthcare limited to the condition for which healthcare was used; the number of severe cases with annual individual healthcare costs of more than €35 000 is known for municipalities due to state refunding policies.12 |
| Healthcare system | ||
| Policy | Macro characteristics of the health system not further specified by Andersen. | With exception of the access model and its implementation, this should be the same for all municipalities in NRW. |
| Resources | ||
| Organisation | ||
| External environment | ||
| Physical | Natural and built environment. | Availability very limited: information on types of accommodation in municipalities (central or decentralised).16 |
| Political | Political context (global, national, state, local). | No difference between municipalities for global, national and state levels; local level: information on population size, organisational structure (eg, independent city, county-affiliated)42 and results from local elections as well as the political party of the ruling major.43 |
| Economic | Economic structure. | No difference between municipalities for global, national and state levels; local level: data available for municipalities in Germany (unemployment rate, average household purchasing power, age structure).42 |
| Health practices | ||
| Personal health practices | Diet, exercise and self-care (not related to seeking care). | Not available. |
AsylbLG, Asylum Seekers’ Benefits Act; eHC, electronic health card model; NRW, North Rhine-Westphalia.