The other health care system in Germany: care for people without health insurance

Abstract

Background A large number of people in Germany have no health insurance. Their access to the official healthcare system is significantly more difficult or impossible. Charitable institutions try to provide medical care and create parallel healthcare structures. Their possibilities and limits are still unknown. Methods This study identified 128 institutions for people without health insurance. A data query was used to determine the status of medical care for uninsured patients. Results Sixty-eight of 128 identified institutions participated in the study. They provided care to 26,300 people, required €7,580,449 for their work, ran doctor's offices (57%), provided mobile care (7.8%), and arranged only medical care (29.6%). Patients of all ages need general, internal and gynecological care. The availability of health care is heterogeneous, and health care is not available throughout the country, especially not for people with limited personal mobility. The most frequent specialties were general medicine, internal medicine, gynecology, psychiatry, and surgery. Even complex care, such as pregnancy, was possible. In a self-assessment using a Likert scale, the median of the subjectively perceived level of care measured against a regular doctor's office for insured patients was 6 of 10. The provision of medicines, medical supplies or specialized medical services depended on private donations and thus on the economic situation in Germany. Participants often used multiple solutions in parallel to conserve available resources. Institutions showed a high level of responsibility to their patients. They were mostly professionally organized, with few full-time staff and many volunteers. Conclusion Medical care for people without health insurance was heterogeneous and not universally available. Comprehensive legislative changes are needed to provide universal basic health care. The establishment of clearing houses and changes in pharmaceutical and tax law could stabilize care for people without health insurance.