It is estimated that up to a million people in Germany live without health insurance. A treatment center in Bremen helps those affected who fall through the system.
A table, two sofas, a few chairs thrown together and a rocking horse as a “play area” – people who aren’t actually allowed to sit in a waiting room are allowed to sit in this waiting room because they don’t have health insurance. Here – in the Medical Treatment Center for Paperless and Uninsured People (MVP for short) in Bremen – there is room for these people.
“To be honest, at first I was a bit afraid to tell everything. For the first time. All the problems I have. But I immediately had the feeling that I was in good hands,” says one person in an evaluation report.
The feeling of being in good hands – that is probably the most important thing here. Because the people who come here are usually not in good hands at all when it comes to their medical and health care. Most don’t have health insurance. They can’t go to the doctor if they feel sick, they can’t get any medication. At least not in the “normal system”.
Offer is well received
These people find help in the rooms of an old doctor’s office not far from Bremen’s main train station: a treatment room, a room that is an office and consultation room in one, plus an old laboratory and a rather provisionally furnished waiting room. The MVP has been around since 2022.
The treatment center is open three days a week. Honorary doctors examine people with minor health problems. If a specialist medical assessment is required, the MVP issues treatment certificates. The clients can then use these to go to private practices or to the hospital. The treating doctors can bill the treatment certificate via the MVP.
The offer has been well received: almost 1,000 people from 76 different countries have visited. There you will also be advised – and this is particularly important – whether and how you might be able to obtain insured status. This is called “clearing” and takes place in a small office, right next to the treatment room.
Advice aims to help in the long term
In this room, Holger Dieckmann and Charlotte Vöhl advise people who would otherwise fall through the system. “For example, we currently have two people in counseling who are 18 and 19 years old and live here with their parents. But they are no longer considered family members because they are of legal age. And then they have no access to the right of residence. And then no access to health care,” says Dieckmann.
But it’s not just people without residency rights who come for advice. The offer is for EU citizens who are entitled to health insurance but are not yet covered by the system, German citizens without health insurance and people who live in Germany without papers.
“The goal is for people to receive medical and health care. That doesn’t have to be here. Ideally, people will then be connected to family doctors’ practices at some point and the care will run through them,” says consultant Vöhl. And that seems to be working to some extent: within a year and a half, 168 people were given insured status.
Similar models in other cities
In many German cities there are similar offers to the treatment center in Bremen. People who do not have health insurance can receive medical treatment using the anonymous health certificate. Aid organizations offer care and advice, and the city or state supports the project financially.
Because there are many people living without health insurance in Germany: experts estimate that there are a good half a million to a million people. The number can only be estimated, because many who do not have health insurance do not appear in the system: homeless people, people without papers, EU citizens who do not have an employment relationship that is subject to social insurance contributions.
Bremen project initially limited
In Bremen, financing for the project is initially secured until the end of 2025. The desire – also of the authorities – is to make the offer permanent. The health authority is supporting the offer with around 1.2 million euros in 2024.
“There is no legal entitlement to this service. It is a voluntary service. That is why it is of course limited. And that is of course a problem. That is clear. But we are coping with the needs that we can now perceive,” says Holger Dieckmann.
Nevertheless, from Dieckmann’s point of view, it would make sense to expand the project. To be able to make a similar offer in other parts of the city. The employees are convinced that health and medical care for all people is a human right.