Zimmer Matthias
Clinic for Emergency Medicine, Ketteler Krankenhaus gGmbH, Offenbach Hesse, Germany.
Malteser Hilfsdienst e.V, Offenbach, Hesse, Germany.
BMC Health Serv Res. 2024 Dec 24;24(1):1649. doi: 10.1186/s12913-024-12119-0.
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.
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.
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.
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.
德国有大量人口没有医疗保险。他们进入官方医疗体系的难度显著加大，甚至无法进入。慈善机构试图提供医疗服务并建立平行的医疗结构。其可能性和局限性仍不为人所知。
本研究确定了128家为无医疗保险人群服务的机构。通过数据查询来确定未参保患者的医疗状况。
128家已确定的机构中有68家参与了研究。它们为26300人提供了医疗服务，工作所需资金为7580449欧元，设有医生办公室（57%），提供流动医疗服务（7.8%），且仅安排医疗护理（29.6%）。各年龄段的患者都需要全科、内科和妇科护理。医疗服务的可及性存在差异，全国并非都能获得医疗服务，尤其是行动不便的人群。最常见的专科是普通科、内科、妇科、精神科和外科。甚至像怀孕这样的复杂护理也可行。在使用李克特量表进行的自我评估中，与参保患者的正规医生办公室相比，主观感知的护理水平中位数为10分中的6分。药品、医疗用品或专业医疗服务的提供依赖私人捐赠，因此取决于德国的经济状况。参与者经常并行使用多种解决方案以节省可用资源。这些机构对患者表现出高度责任感。它们大多组织专业，全职员工少，志愿者多。
无医疗保险人群的医疗服务存在差异，并非普遍可及。需要进行全面的立法变革以提供全民基本医疗保健。设立结算中心以及改革药品和税法可以稳定无医疗保险人群的医疗服务。
