Decrease in Individuals Without Medical Insurance Coverage
In a report published by the Federal Statistical Office (Destatis) on Tuesday, it was revealed that the number of uninsured individuals in Germany decreased by 23 percent compared to 2015. However, the report did not address the impact of the COVID-19 pandemic on the number of uninsured individuals in 2021.
Despite the overall decrease, the uninsured individuals in Germany in 2021 still have no other entitlement to healthcare. The high rate of uninsured individuals, particularly among the self-employed and unemployed, can be attributed to several structural and economic factors related to Germany's health insurance system.
One of the main factors is the complexity of the health insurance system and eligibility rules. Germany operates a dual health insurance system with statutory health insurance (public) and private health insurance. The eligibility for statutory insurance depends on employment status and income level, with employees earning below €73,800/year required to join statutory insurance, while those above can opt for private insurance. For self-employed and freelancers, insurance is voluntary, offering a choice between public and private insurance regardless of income. This flexibility can lead to gaps where some self-employed either opt out or fail to maintain coverage due to costs or lack of obligation.
Another factor is the contribution costs and financial barriers. Contributions to statutory insurance are calculated on income but only up to a ceiling. For self-employed without stable income, contributions can be perceived as high, especially if they earn irregularly or are unemployed, making insurance unaffordable or deprioritized.
Non-standard employment and coverage gaps also contribute to the high uninsured rates. Studies on other countries with advanced insurance markets indicate that non-standard workers face obstacles to insurance participation due to unclear labor relations and lack of social protections—similar factors could apply to self-employed or marginally employed in Germany, increasing uninsured rates among these groups.
About 16 million people in public insurance are exempt from contributions because they are dependents, suggesting that unemployed individuals without dependent coverage may face gaps if not properly registered or entitled to benefits.
To address these issues, several solutions have been proposed. Mandatory insurance for all residents, including self-employed and unemployed, could close gaps. Designing income-adjusted or minimum contribution schemes that account for irregular and low incomes of self-employed individuals would make insurance affordability less of a barrier. Educational campaigns about rights and obligations, along with easier administrative procedures for registration and re-registration during unemployment or self-employment transitions, would mitigate coverage lapses. Government subsidies or direct coverage for vulnerable groups such as the unemployed or low-income self-employed could also be enhanced to ensure continuous coverage.
While the total number of uninsured individuals in Germany in 2021 is not specified in the article, it corresponds to less than 0.1 percent of the total population, which was not specified. Nearly two-thirds of the uninsured individuals were men, accounting for approximately 64 percent, while the remaining 36 percent were women. Self-employed individuals and assisting family members had the highest rate of being uninsured, at around 0.4 percent. As of 2021, the number of uninsured individuals in Germany continues to decrease.
- Health-and-wellness initiatives for chronic diseases and mental health can be helpful in addressing the healthcare needs of members in Germany's uninsured population, especially considering the high number of uninsured individuals among self-employed and unemployed.
- Proper nutrition and fitness-and-exercise routines could be especially beneficial for self-employed individuals in Germany, as they face financial barriers and contribute to the high uninsured rates due to expenses related to health insurance.
- Focusing on medical-condition management and treatments for underserved groups, like the uninsured population in Germany, can contribute to improved overall health and wellbeing, reducing the burden of chronic diseases in society.
- To create a more inclusive health and wellness landscape in Germany, policies should consider the unique challenges faced by both uninsured individuals and marginalized groups, such as understanding and addressing the labor and economic factors that lead to coverage gaps.
