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Background Healthcare provision for asylum seekers differs across Germany. Most states use treatment vouchers as proof of eligibility; i.e., asylum seekers must first obtain a voucher from the welfare office to access healthcare. Since 2016 several states have introduced an electronic health insurance card (EHIC) for asylum seekers that enables access to care akin to statutory insurance. The EHIC has reanimated an old debate about asylum seekers’ health benefits. Opponents claim that medical costs will rise if control over healthcare access is eased. Proponents argue that the EHIC reduces costs through the cutback of administrative workloads and improves access to care. Evidence for either position is scarce. Goal The study goal was to assess the 2016 EHIC introduction in Berlin to enable evidence-informed decision-making. Methods We analyzed claims data that were retrieved from the Berlin Senate Administration and ten semi-structured in-depth interviews with key informants. Interviews were recorded, transcribed and subjected to thematic analysis using ATLAS.ti software. Ethical clearance was obtained. Results Our study found an overall positive evaluation of the EHIC. Although the introduction implied extra efforts and total administrative workloads remained unaltered, the EHIC was said to have the following advantages as compared to treatment vouchers: 1) It simplifies certain work processes and 2) allows for unprecedented financial transparency and control. 3) It eases access to care with 4) no increase in medical costs. Finally 5) the EHIC signifies equality and integration for asylum seekers. Conclusions In light of our study results the common economic arguments against greater inclusion of asylum seekers into public healthcare systems appear unfounded. On the contrary, the example of the EHIC shows that inclusion can create win-win-situations by improving healthcare access, whilst keeping medical costs constant and advancing financial transparency. Key messages In Germany there is a long-standing debate whether easing access to care for asylum seekers will increase health costs. Our case study shows that, on the contrary, the introduction of an electronic health insurance card for asylum seekers can both improve access and have organizational and economic benefits.

A first assessment of the electronic health insurance card for asylum seekers in Berlin