Inadequate health insurance cover in Germany: People’s characteristics, causes and possible solutions - a mixed methods approach

Abstract

Background In the German dual health insurance system, almost 1% of German citizens only have an inadequate insurance cover leading to an impaired medical care. The personals characteristics, the causes of their inadequate cover and the associated health effects are largely unknown, so far. The aim of this study was to obtain a comprehensive overview about those with a limited health insurance cover. Methods The study was conducted using a mixed-methods design. Data was used from two private health insurance companies and one statutory health insurance company. In addition, interviews were conducted with experts from clearing centers that supported the return to a full insurance coverage, with the aim of exploring the causes of the current situation, to identify the challenges in trying to regain full insurance coverage and to capture the health effects. Results The PHI dataset comprised a total number of n = 14.312 and the SHI data set n = 95.325 persons. In the private health insurance system, the most affected people were male, over 40 years and self-employed, while in the statutory health insurance system, the most affected were young male between 20 and 30 years, employees and overproportionate non-Germans. Socio-economic factors, lack of health literacy, and inadequate knowledge about health insurance resulted in an inadequate insurance cover leading to an exclusion from the healthcare system. Conclusion There are particular groups with certain sociodemographic characteristics that are more vulnerable to an inadequate insurance cover. It is therefore important to identify and offer support before an insurance downgrade is carried out. Support from health insurance companies in cooperation with clearing centers and state institutions that provide social benefits is necessary.