gms | German Medical Science

Background and state of research: Estimates suggest that numerous people live without or with limited health insurance coverage in Germany such as EU citizens, undocumented migrants, or homeless persons, and insured persons with insurance contribution debts. Evidence on health outcomes and utilization of medical care among those affected is scarce. However, available studies suggest that uninsurance may lead to lack of access to recommended diagnostics, treatment and preventive services, and poorer health.

Research question and objectives, hypothesis: What is the prevalence of forgone care in persons without or with limited health insurance coverage? To what extent are sociodemographic characteristics and health insurance status associated with forgone care? The study aims to assess the prevalence of forgone care and to identify its determinants among persons without or with limited health insurance coverage in Germany with respect to utilization of inpatient and outpatient care and medication use.

Method: A cross-sectional multilingual written survey of persons without or with limited health insurance is conducted as part of the MoveCitizenS project. Between February and June 2023, clients of six non-profit counselling centres offering social and legal counselling or medical care to people without regular access to health care services in Germany (Bielefeld, Bonn, Düsseldorf, Frankfurt, Wiesbaden) are asked to complete an anonymous standardized questionnaire. A questionnaire that examines dimensions of subjective health status, health care utilization, forgone care and sociodemographic information in six languages was developed in a multi-professional team partly based on validated instruments, and using the TRAPD method for survey translation, including cognitive pretesting. Survey data is compared with nationally representative estimates based on the German Health Update (GEDA 2019/2020-EHIS). Multivariate logistic regression models are used to analyse the association between insurance status and forgone care, adjusted for sociodemographic and health-related confounders.

Results: The results will be available at the time of the Congress on Health Services Research in October 2023.

Discussion: Targeted recruitment and multilingual survey instruments allow for data collection on the health care situation of persons without or with limited health insurance. The findings of the study characterize the type and distribution of self-reported forgone care and may identify barriers to health care utilization.

Implication for care: The findings can serve as a basis to develop policies and targeted public health measures that may play a critical role in improving access to health services for patients without or with limited health insurance. Such measures could have substantial clinical and economic benefits when these prevent complications due to unmet health needs.

Funding: Other funding; Förderfonds zur Finanzierung von Forschungsprojekten mit Bürgerbeteiligung an der HHU