Care gaps in an uninsured population in Germany: insights from open.med Munich.

BACKGROUND: In Germany, people without health insurance face barriers to routine care. open.med Munich provides humanitarian care through Doctors of the World. METHODS: We retrospectively analyzed pseudonymized 2024 routine data on demographics, insurance/residency, housing, access barriers, diagnoses, and emergency referrals. Emergency referral meant an open.med-initiated referral for emergency-level assessment/intervention. RESULTS: In 2024, 984 patients consented to data use, generating 3738 contacts. Of these, 865 (88%) had no health insurance, 890 (91%) were homeless/in precarious housing, and 407 (42%) were legally excluded from German social/health benefits. Emergency referral was required for 54 (5.5%). Among 949 patients with ≥1 diagnosis, the most frequent ICD-10-GM chapters were symptoms/abnormal findings (R00-R99, 215, 23%), respiratory (J00-J99, 183, 19%), circulatory (I00-I99, 178, 19%), health-status/contact factors (Z00-Z99, 166, 18%), digestive (K00-K93, 158, 17%), musculoskeletal/connective tissue (M00-M99, 158, 17%), infectious/parasitic (A00-B99, 149, 16%), injuries/poisoning (S00-T98, 119, 13%), and mental/behavioral disorders (F00-F99, 126, 13%). Among emergency referrals, injuries/poisoning were most frequent (18, 33%), followed by cardiovascular (7, 13%), respiratory (6, 11%), gastrointestinal (6, 11%), and pregnancy-related complications (5, 9%). CONCLUSION: Spectrum comprised common conditions. Structurally obstructed routine care may contribute to delayed presentation and emergency referrals. Reform should include coverage clearing, non-punitive referrals, interpreters, and coordination among emergency, social, insurance, and humanitarian services.