[(No) Treatment for people without health insurance coverage : When access to inpatient surgical care is denied].

Background: For people without health insurance coverage access to healthcare is severely restricted. In large cities such as Frankfurt am Main, parallel structures have emerged to ensure free basic medical care for those affected; however, when inpatient treatment is required the medical infrastructure for people without health insurance is inadequate. This article outlines the importance of access to surgical treatment for people without health insurance and the serious consequences when this access is denied.

Material and method: The Clearing Center 1.0 at the Public Health Authority of Frankfurt am Main and the Elisabeth Street Outpatient Department of the Caritas Association Frankfurt represent two low-threshold outpatient clinics that exist in the city of Frankfurt. The basic structure and function of each clinic are described along with a characterization of the patient populations, including a description of the sociodemographic characteristics. From the total patient collective, three case scenarios are selected as examples and are outlined with respect to (1) social history, (2) access barriers, (3) findings, (4) surgical indications and (5) treatment course.

Results: Patients face complex barriers due to legal restrictions, financial hardships and precarious living conditions. The lack of a funding provider results in necessary surgery not being performed. The consequences are pain, functional limitations and worsening of life-threatening diseases.

Conclusion: Timely surgical care for people without health insurance is essential to maintain health and avoid high follow-up costs. A treatment fund provides a solution. The combination of case management, secure accommodation and raising awareness among professionals helps close care gaps and develop solutions.