Despite compulsory insurance, tens of thousands of people in Germany live without health insurance. The situation is difficult for pregnant women.
Pregnant women without health insurance often face major problems (symbolic image)Imago / Panthermedia
Liana P. trained as a pharmacist in Armenia, then traveled to Poland on a visa to look for work. When the young woman met a fellow countryman living in Rhineland-Palatinate and became pregnant, she moved in with him. But the costs for medical care during pregnancy and birth were not covered by her insurance: In Germany, she could not simply go to the doctor and attend preventive care appointments.
For Claudia Tamm and her colleagues from “Medinetz” in Koblenz Cases like that of the Armenian couple are nothing unusual. The aid organization works for people without health insurance. Not everyone who comes knocking on the door reports in time: “A while ago, a woman came in at the end of the 36th week of pregnancy,” reports Tamm. “Thank God we were at least able to determine her blood type, but of course the hospitals don’t want to experience such surprises.” Sometimes women come into the delivery room in labor, and the position of the unborn child is not even known because they have not been to a doctor beforehand.
Compulsory health insurance since 2007
Since 2007, Germany has had a statutory health insurance requirement. But according to official figures, tens of thousands of people in the country still live without insurance. Including foreigners living illegally in Germany, the number of people affected is probably in the six-figure range. When pregnant, some women without an insurance card do not register until shortly before giving birth – out of fear of the costs or of being deported.
“Medinetz” in Koblenz and other aid organizations in Germany try to negotiate flat rates with maternity clinics and refer pregnant women to doctors’ offices that carry out examinations without charging them. But above all, wherever possible, they try to help with enrolling in a health insurance company in good time before the birth.
Not all pregnant women without health insurance are destitute, and many initially want to cover the costs themselves, says Tamm. But while self-paying mothers are charged around 3,500 euros for a natural birth without complications, in extreme cases the costs for a premature birth requiring intensive medical care can amount to well over 100,000 euros.
Clinics are left with costs
Some young parents therefore start their lives with a child with a huge mountain of debt, says Tamm. In most cases, the hospitals are left with the costs. But the helpers are even aware of cases in which clinics sell their debts to debt collection companies. Other institutions are satisfied if uninsured women pay a sum of 400 euros.
There are various reasons why women find themselves in such a predicament. Many of those seeking help come from Eastern European EU countries who move to Germany legally but cannot find permanent work here. Another group that worries Nele Wilk from the “Poverty and Health in Germany” association are foreign students and pupils at preparatory colleges and language schools.
Pregnancy: Insurance through father not possible
They often come to Germany with travel health insurance that does not cover pregnancy costs from the outset. “As soon as they are properly enrolled at a university, they can decide to switch to a regular health insurance company,” reports Wilk. But there is no obligation to do so, and out of ignorance or to save a little money, many do without it.
At “Poverty and Health,” Wilk works for a clearing house sponsored by the state of Rhineland-Palatinate that aims to help people without insurance get back into the regular system. For Germans, such as those with private insurance and high debts, a solution can usually be found. But for foreigners, this is not always possible.
Happy ending for pregnant Liana P.
In the case of pregnant women, it doesn’t even help if the child’s father has a secure residence permit and health insurance: family insurance for the child through the father is possible – but only after the birth. The call for a state emergency fund has so far gone unheeded, as the federal government, states and municipalities all point to a lack of responsibility. “We are very tired right now,” says Wilk. “The people, but also the hospitals, are being let down.” The state capital Mainz is acting in an exemplary manner, with its social welfare office negotiating a flat rate for uninsured women with the hospitals.
For Liana P. and her child, it was a happy ending: “Medinetz” organized the Armenian woman’s care, and the costs were paid with the help of the family. The mother – who now has health insurance – and the father and their eight-month-old son now live in the Koblenz region. The only thing that hasn’t worked out so far is the planned wedding due to bureaucratic hurdles. But that’s another story.
