Health care for unborn children, children and teenagers without health insurance coverage in Germany

Aim: Despite the legal obligation to possess health insurance in Germany, not all underage patients have health insurance. The exact number of people affected is uncertain. The aim of our study was to determine the care situation for children and teenagers in medical institutions that serve people without health insurance. Methods: A systematic online search was used to identify 128 medical care institutions for uninsured people. The participating institutions received a structured questionnaire that aimed to record their paediatric care situation in 2022. In addition, the central care dataset of Malteser Hilfsdienst from 2018 to 2021 was evaluated. Results: Sixty-eight of the 128 (53%) institutions participated. A total of 4% (371) of all patients were younger than 18 years, with a mean of 7 per institution. A total of 94% of the institutions provided care for unborn children, 59% performed deliveries and 29% provided midwives. A total of 72% of the institutions provided paediatric care, 32% provided dental care, 55% provided vaccinations, 99% were able to provide medication and 47% were able to provide glasses. Conclusions: Charitable medical institutions for people without health insurance regularly treat underage patients. Laws have to be harmonized, and clearing centres and anonymous treatment vouchers could be established. Charitable institutions could be financed by the government, and public health services could offer care to ensure health care for children and adolescents.