A number of patients have already arrived in the waiting room of the Stuttgart practice of “Maltese Medicine for People without Health Insurance”. General practitioner Wolfgang Steigleder, who works in the practice on a voluntary basis, begins his consultation hours promptly at 10 a.m.
His first patient is Georgian. The 56-year-old drags himself into the treatment room with crutches because he has a large bandage on his foot. The diabetic had two toes amputated. On a couch, Wolfgang Steigleder carefully removes the gauze bandage and the sterilized wound dressing. “The wound has healed well,” explains the retired doctor. This makes him happy because wound healing is much slower for diabetics and they suffer from serious secondary illnesses if they do not receive regular medical care and support.
The patient lives in Baden-Württemberg and, like most patients, wants to remain anonymous. Mostly out of fear, caution or shame.
In the Stuttgart practice for people without health insurance, the number of patients has tripled in the last two decades. Many come from third countries or the European Union. If the language barrier is too great, you can use translation aids, says Steigleder.
In addition to homeless people and people without a valid residence status, the patients also include students, pensioners and many solo self-employed people who cannot or can no longer afford the contributions to statutory or private health insurance.
A Croatian patient worked as a self-employed interior fitter on German construction sites for five years. On the recommendation of his client, he took out private travel health insurance and tried to be included in statutory health insurance. Without success. Then came Corona and, with the pandemic, the professional downturn. A short time later he suffered a heart attack and a pulmonary embolism.
The now 60-year-old says that he is still paying off the hospital costs of 4,200 euros in small installments. If he wants to take out statutory or private health insurance, he would have to pay back the insurance contributions for the last ten years, because he has been living in Germany for that long. But he couldn't afford that, the patient continued.
In a clearing house, which is housed in a niche in the practice rooms, employees advise patients to show them a way into the regular healthcare system. Patients are often overwhelmed by clarifying their insurance situation and bureaucratic hurdles make it difficult for them to find their way. Each case is an individual case, explains a social worker at the clearinghouse, and that shows how complex our health system is.
She looks for solutions together with the patients. Some have slipped into emergency or rest tariffs because they owe contributions, or refugees are generally only entitled to treatment for acute illnesses and pain in the first three years.
And others, like the Croatian patient, were completely excluded from insurance coverage. Patients suffering from diabetes also urgently need to have access to regular doctor's visits, says doctor Steigleder. Because diabetes is a chronic disease. If the patient is not regularly monitored and treated by a doctor, this could have life-threatening consequences.
The practice in the south of Stuttgart is bursting at the seams. They are looking for suitable consultation rooms in order to be able to expand the clearing house, says Regine Martis, who coordinates the area at the Malteser. The number of patients has tripled in the past two decades: from 145 to 413 patients.
Patients come to us with the entire range of illnesses, from respiratory infections to heart attacks, says Regine Martis. Also pregnant women or people who are terminally ill and need palliative care. But in addition to the treatment, it is extremely important that patients find a place in our health insurance system. "We are seeing good results, namely that half and perhaps even more than half of the patients can actually be placed in health insurance."
