esanum: Dr Heinrich, every day more people in Ukraine leave their homes to seek safety somewhere - and many of them are coming to Germany. What does that mean for medical care in the country?
Dr. Heinrich: We have to prepare for large refugee flows. About 51 million people live in Ukraine. If only ten percent of them head west, that would be over five million people. And we have to reckon with that. These people need medical care in hospitals and surgeon practices.
esanum: How is this support organised, for example after a family arrives at Berlin's main train station, in the night?
Dr. Heinrich: This is now a fairly standardised procedure. As soon as they report to the arrival centre, they get medical treatment vouchers or even an AOK (German health insurance) card. With this, they can be treated like anyone else in the health insurance system, first by the family physician and then by referral to the specialists.
esanum: Who pays for the medical care of those arriving?
Dr. Heinrich: We bill the physician associations of statutory health insurance through the normal procedures and they collect the funds from the respective authorities. Apart from the language barriers, there are no major hurdles in the care of the new arrivals.
esanum: And how can medical colleagues in private practice manage language barriers and communication issues with those in need of care?
Dr. Heinrich: They have to be creative themselves. The best we can do is to tell patients when they make an appointment that they should bring someone with them to help them communicate, if possible. Many have relatives here. Some colleagues also have staff who speak the language.
esanum: Is there any experience you can draw on for the current events?
Dr. Heinrich: It is very similar to 2015, when it took a while to secure healthcare supply. In the beginning it was very difficult. There were different accounting channels, it was too complicated. But now we can build on the processes that were set up back then.
esanum: A lot of people are expected to arrive in the next few weeks or months. What does that mean in concrete terms for the medical care landscape?
Dr. Heinrich: First of all, as people are provided with a roof over their heads, corresponding medical resources will be needed. Let's assume that several million people arrive, then the system will definitely receive a jolt. We can't just add millions of people to the existing system and expect that it will be business as usual. Everyone will have to wait longer for appointments, maybe even for surgeries, because capacity cannot be ramped up so quickly.
esanum: Who should be in charge of creating a cushion to prevent a medical system overload?
Dr. Heinrich: The politicians are responsible for that, both in the federal government and also in the regional governments where the displaced populations are arriving. The main thing now is to inform local populations about the refugee situation, to explain the wider healthcare implications, and that there will be waiting times. You have to be honest and admit: ‘it will be a difficult time, if we need to provide for millions of additional patients’. It's all about communication - as it almost always is.
esanum: How great is the willingness of physicians to give their best in this special situation?
Dr. Heinrich: Motivation is very high. That was already the case in 2015. But now we also had the COVID context. We must not forget that.
esanum: What is the health situation and vaccination status among the arriving Ukrainians?
Dr. Heinrich: The new patients are asked about all types of vaccinations as soon as they come to the physicians. I am not yet aware of any figures on this. There may also be some cases of tuberculosis and measles. We already know this from the 2015 refugee influx and we are prepared for it.
Dr. Dirk Heinrich is a specialist in Ear, Nose & Throat (ENT), general medicine, and chiropractic. He works as a physician at the Marienkrankenhaus Hamburg (Germany). In addition to his chair position at the German SpiFA, he is also president of the Deutscher Berufsverband der Hals-Nasen-Ohrenärzte (German professional association of ENT specialists), and federal chairman of the Virchowbund (Association of General Practitioners in Germany).