The Senator for Health, Women and Consumer Protection has commissioned Prof. Dr. Ansgar Gerhardus from the Institute of Public Health and Nursing Research at the University of Bremen to evaluate the pilot project on medical care for people without health insurance, which was launched in Bremen in 2022. The results were to provide the basis for a decision on the continuation of the model beyond 2023. The objectives of the evaluation were: (1) the analysis of clients with a perspective on needs-based access; (2) the quantitative assessment of care; (3) the recording of satisfaction with the care processes; (4) the survey of the perceived quality and appropriateness of care and (5) the assessment of the use of resources / economic aspects. For the evaluation, a mixed-methods approach combining qualitative and quantitative methods was chosen. The IPP team conducted semi-structured interviews with staff from the MVP, with billing healthcare providers, with MVP clients, and with organizations that refer to the MVP. Additionally, a survey was conducted with billing healthcare providers. Routine data collected at the MVP and by GeNo was also analyzed.
According to the authors of the evaluation study, the three objectives of the MVP defined at the start of the project were achieved:

•    People who previously had no access to outpatient or inpatient treatment or to the provision of medication and aids were given access with the help of treatment certificates. From July 2022 to the end of 2023, a total of 5,086 consultations, treatments or treatment certificates were issued at the advice and treatment center.
•    The clearing procedure enabled previously uninsured people to be admitted to regular health insurance.
•    Due to the low-threshold services offered by the MVP, initial care can begin at an earlier stage, which suggests that this may help prevent severe disease progression.

The facts:
The evaluation determined that an average of 180 people have been using the advice and treatment center per month since July 2022. Around 60 percent of users were medically examined and treated there. From July 2022 to the end of December 2023, 2,933 treatment certificates were issued. Since the start of the project, a total of 168 people have gained access to statutory or private health insurance through the advice service, 142 were insured without knowing it or making use of their health insurance. A total of 886 people took advantage of the offer to clarify their insurance status.

Background:
People without proof of residence status as well as certain citizens of the European Union and some people with German citizenship have no or limited access to adequate healthcare in Germany. In Bremen, a draft resolution on “Securing medical and health care for people without health insurance and paperless people in Bremen - a pilot project” was submitted to the Deputation for Health and Consumer Protection on May 3, 2022 in order to achieve three goals:  
1.    to provide people who temporarily or permanently have no access to regular billed healthcare with access via treatment vouchers
2.    the integration of clearing so that these people can be integrated into regular care
3.    low-threshold access and primary care should prevent or mitigate serious illnesses in the long term by identifying and treating health problems at an earlier stage.
Since 15.8.2022, the “Advice and Treatment Center of the Association for the Promotion of Health and Medical Care for Uninsured and Paperless People in Bremen e.V.” has been offering medical consultations and advice in clearing on its own premises. Treatment vouchers are issued for any further care that may be required, which can be redeemed with medical and non-medical providers.
No reliable figures are available on the number of people without health insurance in Bremen. Estimates assume a figure in the lower four-figure range. In the view of the Bremen Senate, this showed the urgent need for action to enable or at least facilitate access to the healthcare system for the groups of people mentioned. On 23 October 2019, at the request of the Left Party, SPD and Alliance 90/The Greens parliamentary group (printed matter 20/112), the parliament called on the Senate to draw up a concept to ensure specialist medical care for people without pets in particular and to guarantee their extensive integration into the standard care system. In 2022, the pilot project “securing medical and health care for people without health insurance and paperless people in Bremen” was founded as the project sponsor for the city of Bremen. Funds of 550,000 euros were made available for the costs of health and medical care, management and human resources in 2022, 900,000 euros in 2023 from the Bremen Fund and 1.2 million euros in 2024 in the regular budget.

Source:

Pressemitteilung der Senatorin für Gesundheit, Frauen und Verbraucherschutz vom 13.08.2024
https://www.senatspressestelle.bremen.de/pressemitteilungen/abschlussbericht-der-gesundheitsdeputation-vorgelegt-451573?asl=bremen02.c.732.de
Final Report:
Gerhardus A, Oeltjen L, Schaaf M, Göbberd L, Gerstl S. Abschlussbericht. Evaluation des Projekts: „Förderung der medizinischen und gesundheitlichen Versorgung von nichtversicherten und papierlosen Menschen in Bremen – ein Modellprojekt“ im Auftrag der Senatorin für Gesundheit, Frauen und Verbraucherschutz. Bremen: Universität Bremen Institut für Public Health und Pflegeforschung; 2024. Abrufbar unter:  URL: www.sd.bremische-buergerschaft.de/sdnetrim/UGhVM0hpd2NXNFdFcExjZUEIo45atxh4mPxu5hNPOlSWjHKYmGVvj9qVIMZbsOhp/L_Teil_B_Abschlussbericht_MVP_Anlage.pdf

Contact:
Prof. Dr. med. Ansgar Gerhardus, M.A., MPH
University of Bremen

Institute of Public Health and Nursing Research
E-Mail: ansgar.gerhardus@uni-bremen.de
Phone: +49(0)421-218 688 00
https://www.uni-bremen.de/en/institute-of-public-health-and-nursing-research/departments-working-groups/public-health-research/health-services-research