[Evaluation of a Model Project for the Medical Care of People without Health Insurance in Bremen].

Abstract

Background: It is estimated that between 0.5 million and 1 million people live without health insurance in Germany. Medical care provided by municipalities, charitable organizations, or voluntary services is very limited in scope. To improve healthcare access for these people, the federal state of Bremen established a counseling and treatment center as part of a pilot project (MVP) in 2022. It offers low-threshold medical consultations and care on-site through a supporting association, counseling on potential (re)integration into health insurance entitlement ("clearing"), and the issuance of treatment vouchers for care within the regular healthcare system. The aims of the project evaluation were to analyze healthcare and cost data as well as the perspectives of stakeholders and users.

Methods: Healthcare data were collected by the MVP and cost data additionally by the Gesundheit Nord Bremen hospital network. Interviews were conducted with five MVP staff members, eight billing healthcare providers, three users, and eight employees of organizations supporting these populations. Billing healthcare providers were also addressed in an online survey. Quantitative data were analyzed descriptively, qualitative data by content analysis.

Results: Between July 1, 2022, and December 31, 2023, a total of 971 individuals from 76 countries utilized the MVP services. A total of 91.2% of users participated in at least one clearing consultation; for 142 (16%) of them, there was insurance coverage, and for another 168 (19%), insurance coverage was established. In total, 2,933 treatment vouchers were issued. Overall, €1,327,679 were spent, of which 52% was for inpatient and 10.5% for outpatient treatments. Interview and survey results showed high satisfaction with access to and quality of care. Particularly highlighted were improvements in specialist treatment and the reduction of financial barriers for those involved. Challenges identified included limited staffing capacity, uncertain financial security of the project, restricted geographical accessibility, and language barriers.

Conclusions: The model project led to a significant improvement in healthcare provision for uninsured individuals. Limitations included restricted resources and high inpatient costs. However, it remains unclear how many people in need did not utilize the service. A temporal and geographical expansion of the model project is recommended.