Because of their often-dramatic, life-threatening flight patterns and resulting pronounced health disparities, many refugees have a great need for medical treatment after arrival to their host countries. In Germany, refugees whose asylum application is not approved or whose duration of stay has not yet exceeded 15 months must request doctor visits, with a considerable amount of bureaucracy, from the local responsible authority. Since 2016, however, several federal states and municipalities in Germany have introduced electronic health cards (eHCs) which give refugees immediate and unbureaucratic access to the healthcare system. We examine whether being eligible for eHCs because of this policy change had an effect on multidimensional health indicators for refugees in Germany. For empirical identification, we take advantage of variation in policy adoption across German regions and over time. Relying on the IAB-BAMF-SOEP Survey of Refugees, we find that being eligible for eHCs because of the policy change improved the mental well-being and subjective health assessment of recently arrived refugees, while having no impact on physical health status. These results can be traced back to the moderating effect of facilitated healthcare access on post-migration stress, which is known to affect primarily psychological well-being. Moreover, facilitated healthcare access appears to alleviate potential language and cultural barriers faced by refugees with low health literacy (measured by the ability to read or write in the origin-country language). Altogether, the article illustrates how structural and institutional constraints may shape individual health outcomes of adult refugees.

由于他们经常经历剧烈的，危及生命的飞行方式以及由此造成的明显的健康差异，许多难民到达其收容国后非常需要医疗。在德国，庇护申请未获批准或停留时间未超过15个月的难民必须向当地负责机构视察，并有相当多的官僚作风。但是，自2016年以来，德国的几个联邦州和直辖市推出了电子健康卡（eHCs），使难民能够立即，不官僚地使用医疗系统。我们检查是否符合eHCs的条件由于这项政策变更，对德国难民的多维健康指标产生了影响。为了进行实证鉴定，我们利用了整个德国地区以及随着时间的推移采用不同政策的优势。依靠IAB-BAMF-SOEP难民调查，我们发现有资格获得eHCs由于政策变化，改善了对新近抵达难民的心理健康和主观健康评估，同时对身体健康状况没有影响。这些结果可以追溯到便利的医疗保健对迁移后压力的调节作用，众所周知，迁移后压力主要影响心理健康。此外，便利的医疗保健似乎减轻了健康素养低的难民面临的潜在语言和文化障碍（通过以原籍国语言读写的能力来衡量）。总而言之，本文说明了结构和制度上的制约因素如何影响成年难民的个人健康状况。