Abstract Background Responsiveness, a critical component of health system performance, has received little attention in the context of international migration. Yet the concept provides a unique lens to study the system's ability to meet the legitimate expectations of its users. This study aims to identify predictors of responsiveness for asylum seekers and refugees (ASR) in Germany. Methods A population-based, cross-sectional health monitoring survey was conducted in Germany's third-largest federal state using random sampling at the level of all 1938 accommodation centers. Established instruments were used to measure responsiveness, health status, and socio-demographic factors. Data were weighted for sampling design and calibrated using asylum statistics. Adjusted logistic regression models were applied to identify predictors of responsiveness related to health status, structural, and socio-demographic variables. Results Of 560 respondents (response rate: 42%), 344 provided data on responsiveness. Combined weighted scores for responsiveness were 75% (CI: 69%-82%), with large variations between domains ranging from 86% (CI: 80%-90%) for cleanliness and 83% (CI: 76%-89%) for respect domains, to 56% (CI: 48%-63%) for choice and 52% (CI: 46%-59%) for timeliness domains. Overall responsiveness was worse for ASR with poor general health (OR 0.35; CI: 0.14-0.84), chronic illnesses (OR: 0.37; CI: 0.17-0.81), symptoms of depression (OR: 0.37; CI: 0.15-0.90) and anxiety (OR: 0.26; 0.10-0.68), and poor quality of life (OR: 0.18; 0.06-0.60). Socio-demographic and structural factors were not significantly associated with responsiveness. Conclusions There is room for improvement, especially regarding choice of provider and timeliness of care for ASR in Germany. Poor health status is a predictor of responsiveness, indicating that ASR most in need of a supportive care environment are being sold short. There is therefore an inequitable distribution of health system responsiveness among ASR. Key messages There is a large variation in scores across responsiveness domains, with choice of provider and timeliness of the health system being rated as particularly poor by ASR. Responsiveness is worse for individuals with poor health status, indicating that those most in need of a supportive care environment are being sold short.