Neupert Ingo, Pieper Claudia
Sozialdienst, Universitätsklinikum Essen, Essen.
Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen.
Gesundheitswesen. 2020 Dec;82(12):955-960. doi: 10.1055/a-1205-1069. Epub 2020 Aug 31.
In Germany, a number of people remain without health insurance, thus unable to access the formal health care sector. Reliable statistics covering the prevalence and description of uninsured patients, especially in the inpatient health care sector, are still lacking. Our study therefore aimed to assess the prevalence of uninsured patients at University Hospital of Essen over a period of five years. Furthermore, we report rates of identification of cost providers and refunded disbursement.
Uninsured patients from 2014-2018 were included. We defined the following subgroups for stratification according to the right of access to health insurance: patients with right of access to health insurance in Germany, EU citizens, patients from third countries, patients without residence permit status.
Data of 918 uninsured patients (mean age 31.3±20.6 years, 52,1% men) from 2014 to 2018 were evaluated. Over five years, identification of cost provider was successful in 74% and yielded in a total refund of 7.5 million Euros. In most instances, patients were treated in the gynaecological and maternity clinic (20%), paediatric clinic (17%), orthopaedic clinic and trauma surgery (14%) and the clinic for internal medicine (13%).
Our study shows that there are still people in Germany who do not have health insurance. Referring to the inpatient health care sector, results show that it is possible to calculate treatment costs, to identify cost providers and to refund medical costs. To apply target group-specific approaches in practice, more research is needed addressing both causes and risk factors. The availability of comprehensive data could improve discussions at a political level on medical compensation not available to patients.
在德国，仍有一些人没有医疗保险，因此无法获得正规医疗保健服务。目前仍缺乏涵盖未参保患者患病率及情况描述的可靠统计数据，尤其是在住院医疗保健领域。因此，我们的研究旨在评估埃森大学医院五年期间未参保患者的患病率。此外，我们报告了费用承担方的识别率和已退还的支出情况。
纳入2014年至2018年的未参保患者。我们根据医疗保险参保权定义了以下分层亚组：在德国有医疗保险参保权的患者、欧盟公民、来自第三国的患者、无居留许可身份的患者。
对2014年至2018年918例未参保患者（平均年龄31.3±20.6岁，52.1%为男性）的数据进行了评估。五年间，74%的费用承担方识别成功，总计退还750万欧元。大多数情况下，患者在妇科和产科诊所（20%）、儿科诊所（17%）、骨科诊所和创伤外科（14%）以及内科诊所（13%）接受治疗。
我们的研究表明，德国仍有一些人没有医疗保险。就住院医疗保健领域而言，结果表明可以计算治疗费用、识别费用承担方并退还医疗费用。为了在实践中应用针对特定目标群体的方法，需要更多关于原因和风险因素的研究。全面数据的可用性可以改善政治层面关于患者无法获得医疗补偿的讨论。
