Emergency solution clearing center: Helpful, but not enough

People without papers or health insurance find it difficult to obtain medical care. Clearing centers support those seeking help. But there are still gaps and there is no nationwide concept.

Anyone who falls ill in Germany goes to the doctor or hospital. They may have to wait a little longer for an appointment, but they can be sure that they will be helped. But that doesn't apply to everyone.

In Germany, hundreds of thousands of people have very limited access to healthcare or are even effectively excluded from it:

• People without papers who cannot assert their claims for outpatient treatment because social welfare office staff are obliged to report them to the immigration authorities;
• EU citizens who are affected by the Exclusion of Benefits Act and are therefore cut off from all healthcare - even in an emergency;
• Asylum seekers for whom the Asylum Seekers Benefits Act restricts entitlement to benefits;
• german citizens without health insurance or who owe contributions.

Clearing centers should help: Pilot projects now also in Berlin and Munich

Special clearing centers and emergency funds, such as those set up in Hamburg and Düsseldorf in 2015 and in Cologne, Duisburg, Dortmund, Münster and Gelsenkirchen in 2016, are intended to help ensure that these people receive medical care.

In concrete terms, this means that their legal residence and social status is clarified in a protected space and an individual assessment is made as to whether they can be placed in the regular healthcare system.

Experience from existing pilot projects shows that a large proportion of people can be integrated into the regular system. For all others, money from funds is needed to finance the necessary medical care.

A large proportion of people can be integrated into the regular system

The scope of services covered by the clearing centers generally relates to medical and dental services in accordance with Sections 4 and 6 of the Asylum Seekers Benefits Act. This includes the treatment of acute illnesses and pain as well as all examinations and treatments relating to pregnancy and childbirth.

Last month, such a clearing house was also set up in Berlin and Munich.

60.000 people without health insurance in Berlin alone

The Berlin clearing center is initially limited until the end of 2019. A total of three million euros is available for this period. It is estimated that 60,000 people live without health insurance in the capital.

"As a contact point, the clearing center has the task of helping those people who have slipped through the cracks of our healthcare system to find their rights," said Berlin's health senator Dilek Kolat (SPD) at the opening in early October.

However, organizations that look after the uninsured expressed criticism of the concept in advance. In an open letter, the signatories - including Flüchtlingsrat Berlin, Gesundheitskollektiv Berlin and Medibüro Berlin - regretted that important key points of the project, which was developed together with experts, had "seemingly fallen out of focus".

The "Welcome Center" set up by the City Mission, which is housed in simple containers at Berlin Central Station, is primarily aimed at homeless people.

Certain groups could fall through the cracks again

Other target groups could easily fall out of focus or fall through the cracks again, particularly people without papers (such as rejected asylum seekers) and new EU citizens without insurance.

Another point of criticism is that, unlike originally planned, the clarification of residence law issues, social counseling (clearing) and the issuing of health insurance certificates are no longer bundled in one place.

People seeking help therefore have to go to different places. "It is unclear to us how anonymity and low thresholds are to be maintained," says the open letter. The City Mission then invited the critics and other cooperation partners to a meeting. Many constructive suggestions for improvement were made, which will hopefully be taken into account during implementation.

The "Munich model"

Since 1998, the City of Munich and independent providers (Malteser Migrantenmedizin, Café 104 e. V. and Ärzte der Welt) have been cooperating in the so-called Munich Model, in which social counseling and emergency medical assistance for people without insurance cover are closely linked.

"The restrictions under the Asylum Seekers' Benefits Act remain in place"

At the end of October 2018, the Munich City Council decided across political groups to set up a clearing center. As part of this, existing health funds will also be merged and subsidized with 500,000 euros per year to ensure healthcare for undocumented migrants in particular.

Café 104, which has been supporting undocumented migrants since 1998 and was previously run exclusively on a voluntary and donation basis, was also promised financial support.

Good developments, but no sustainable solutions

"In principle, these are positive and welcome developments," says Tanja Gangarova, Migration Officer at Deutsche AIDS-Hilfe.

"Unfortunately, most of the clearing centers are temporary and capped. This means that no sustainable and comprehensive effect is achieved. It would be desirable for the federal government to finance the establishment of clearing centers nationwide as a pilot project. A wish that is supported by many alliance partners such as Diakonie, Doctors of the World and Poverty and Health."

"If all people could exercise their rights, these parallel structures would be superfluous"

However, this would by no means really solve the problems. "For people who cannot be integrated into standard care, basic care can usually be provided as part of emergency funds, but the restrictions under the Asylum Seekers Benefits Act remain in place," explains Tanja Gangarova.

"Due to the capped fund financing, expensive services can only be financed in exceptional cases, let alone the long-term coverage of antiretroviral therapy for HIV-positive people."

Tanja Gangarova is certain that voluntary work in and with parallel structures will continue to be of great importance in basic care. "That's actually annoying! Because if everyone could exercise their rights - including the right to health - these parallel structures would be superfluous."

By Axel Schock