Medical Care For People In Precarious Living Situations In Germany: Comparative Analysis Of Five Clearing Centers

In addition to unemployment, poor living and housing conditions and increased morbidity, precarious living situations are often characterized by a lack of or inadequate health insurance. In the Federal Republic of Germany, there is a difficult-to-quantify number of people who, for various reasons, have only limited health insurance coverage or none at all. Those affected include German citizens, EU citizens, and non-EU-citizens who are frequently homeless and/or undocumented. Health care for those groups is predominantly provided outside the German health care system by voluntary non-governmental and welfare organizations. Several German states and municipalities together with non-governmental organizations have addressed this problem by establishing clearing centers often combined with cost reimbursement for medical treatment. In this article, five of these projects are analysed and compared with each other with regard to their structure and mode of operation. The results show that many people can be helped in this way, but in order to meet the high and increasing demand, effort must be put towards more comprehensive solutions as well as on the expansion and sustainability of these projects. At the same time, there is an urgent need to improve statistical and epidemiological data.