Institute for Occupational, Social, and Environmental Medicine, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
Int J Equity Health. 2023 Jun 19;22(1):117. doi: 10.1186/s12939-023-01930-6.
Health insurance is mandatory in Germany; nevertheless, many individuals there have no health insurance and depend on a parallel healthcare structure. Voluntary associations, such as MediNetz and healthcare vouchers ("Anonymer Krankenschein" - AKS), support uninsured citizens. This study aimed to provide insights into associations, such as MediNetz and AKS that provide healthcare for individuals without health insurance in North Rhine-Westphalia, the largest federal state in Germany.
A mixed methods approach was chosen. A qualitative study using interviews with experts was performed to gain their knowledge and explore the various challenges that AKS and MediNetz associations faced and the possible improvements that could be made. A quantitative survey was conducted to analyse the demographic data of the patients who required AKS or MediNetz's assistance and the characteristics of each association through a separate questionnaire. Data was received from the association in Aachen, Bielefeld, Bonn, Düsseldorf, and Essen.
More women than men sought medical care; most were between 25 and 49 years old. The proportion of individuals without residency status accounted for the largest share (53.6%). Common reasons for patients to make contact were acute illnesses (40.2%) and pregnancies (22.3%). Most patients were sent to gynaecologists and general practitioners. Asking the experts, it became apparent that the existing system could not reach the standard of the regular healthcare in Germany. Financial and human resources were insufficient. Therefore, prevention was limited, especially chronically ill patients or patients with a severe illness requiring hospitalisation could not be treated. AKS had advantages compared to MediNetz, as the care came closer to the expected German medical standards.
The results showed a demand for associations providing healthcare for individuals without health insurance. However, the healthcare provided by MediNetz and AKS did not reach the standard of healthcare in Germany and mainly depended on the organisations' resources. Funded projects such as an AKS combined with clearing centres significantly improved healthcare. Until structural measures are implemented, they can be a transitional solution by spreading nationwide.
在德国，健康保险是强制性的；然而，许多人没有健康保险，依赖于并行的医疗保健结构。志愿协会，如 MediNetz 和医疗券（"Anonymer Krankenschein" - AKS），为没有健康保险的公民提供支持。本研究旨在深入了解北莱茵-威斯特法伦州的 MediNetz 和 AKS 等为没有健康保险的个人提供医疗保健的协会，北莱茵-威斯特法伦州是德国最大的联邦州。
采用混合方法。进行了一项使用专家访谈的定性研究，以获取他们的知识并探索 AKS 和 MediNetz 协会面临的各种挑战，以及可能的改进措施。通过单独的问卷对需要 AKS 或 MediNetz 援助的患者的人口统计学数据和每个协会的特征进行了定量调查。数据来自亚琛、比勒费尔德、波恩、杜塞尔多夫和埃森的协会。
寻求医疗的女性多于男性；大多数年龄在 25 岁至 49 岁之间。没有居住身份的人的比例占最大份额（53.6%）。患者联系的常见原因是急性疾病（40.2%）和怀孕（22.3%）。大多数患者被转介到妇科医生和全科医生。向专家询问后，显然现有的系统无法达到德国常规医疗保健的标准。财务和人力资源不足。因此，预防措施受到限制，特别是慢性疾病患者或需要住院治疗的重病患者无法得到治疗。与 MediNetz 相比，AKS 具有优势，因为护理更接近预期的德国医疗标准。
结果表明，人们对为没有健康保险的个人提供医疗保健的协会有需求。然而，MediNetz 和 AKS 提供的医疗保健没有达到德国的医疗保健标准，主要依赖于组织的资源。像 AKS 与清算中心相结合的资助项目显著改善了医疗保健。在实施结构性措施之前，它们可以通过在全国范围内传播成为一种过渡性解决方案。
