Specialist medical centres for the homeless in Hamburg - diagnoses and reasons for treatment compared to general practice system (regular care system)

Abstract Background: Homeless people in Germany are generally entitled to health care within the regular care system. However, due to their specific living conditions, they make little use of these services. In 2013, three specialist medical centres for the homeless (MCH) were opened in Hamburg to provide general health care. The aim of this abstract is to offer an overview of the specific health conditions and health care needs prevalent among the homeless and to discuss whether it is possible to link these patients up with the regular health care system. Methods: Medical data from 840 homeless patients as well as from a total of 1,982 consultations was obtained from 2013 until the end of 2014. In addition, the study evaluated data obtained in a questionnaire on the use of the regular health care system. Health insurance status and diagnosis were routinely documented and categorised using ICD 10 and ICPC-2. Subsequently, the diagnoses and reasons for consultations of homeless patients were compared with data from general practices (GP). Questionnaires on the use of the regular health care system were also evaluated. Results: The most frequent reasons for consultations in the first year were skin conditions (24%), musculoskeletal conditions (16%) and psychological disorders (14%). By comparison, the most frequent reasons for consultations in a general practice were musculoskeletal conditions (22%), conditions affecting the digestive system (14%) and skin conditions (12%). 35% of the homeless patients mentioned a lack of health insurance as the reason for “not making use of” the regular health care system, while ten percent reported that they were unable to visit a GP due to physical or psychological reasons. The longitudinal analysis over six years (2015–2020) showed that 53% of the patients attending the medical centre for the homeless had no medical insurance. Conclusion: The MCH mainly sees patients with medical conditions typical for the homeless cohort, namely skin diseases, wounds and injuries and behavioural disorders due to alcohol abuse. Health care for homeless patients is time-consuming and expensive. Chronic diseases that are equally present in general practice and specialist medical centres, such as diabetes mellitus, pose a great challenge. The lack of health insurance poses the greatest hurdle to the integration of the homeless into the regular health care system.