Care gaps in an uninsured population in Germany: insights from open.med Munich

In Germany, people without health insurance face barriers to routine care. open.med Munich provides humanitarian care through Doctors of the World.

We retrospectively analyzed pseudonymized 2024 routine data on demographics, insurance/residency, housing, access barriers, diagnoses, and emergency referrals. Emergency referral meant an open.med-initiated referral for emergency-level assessment/intervention.

In 2024, 984 patients consented to data use, generating 3738 contacts. Of these, 865 (88%) had no health insurance, 890 (91%) were homeless/in precarious housing, and 407 (42%) were legally excluded from German social/health benefits. Emergency referral was required for 54 (5.5%). Among 949 patients with ≥1 diagnosis, the most frequent ICD-10-GM chapters were symptoms/abnormal findings (R00-R99, 215, 23%), respiratory (J00-J99, 183, 19%), circulatory (I00-I99, 178, 19%), health-status/contact factors (Z00-Z99, 166, 18%), digestive (K00-K93, 158, 17%), musculoskeletal/connective tissue (M00-M99, 158, 17%), infectious/parasitic (A00-B99, 149, 16%), injuries/poisoning (S00-T98, 119, 13%), and mental/behavioral disorders (F00-F99, 126, 13%). Among emergency referrals, injuries/poisoning were most frequent (18, 33%), followed by cardiovascular (7, 13%), respiratory (6, 11%), gastrointestinal (6, 11%), and pregnancy-related complications (5, 9%).

Spectrum comprised common conditions. Structurally obstructed routine care may contribute to delayed presentation and emergency referrals. Reform should include coverage clearing, non-punitive referrals, interpreters, and coordination among emergency, social, insurance, and humanitarian services.