title: [Over-indebtedness and additional payments to the German health-care system - discrimination upon destitution in expenditure].
abstract: OBJECTIVE
  In the past few years, the number of over-indebted private households in Germany has steadily increased and is currently estimated to have reached 3.13 million. Financial difficulties culminating in private insolvencies of the persons concerned may lead to a restrained usage of health-care services that require additional payment. For the first time ever this study has examined whether over-indebted individuals refrain from seeking medical treatment or from buying prescribed medicine because of their financial situation.
  
  
  METHODS
  The cross-sectional study covered over-indebted persons in Rhineland-Palatinate and was conducted between July 2006 and March 2007. In cooperation with 53 debt counselling agencies in Rhineland-Palatinate and in cooperation with the specialized debtor counselling centre of the Johannes Gutenberg-University of Mainz a singular, anonymous questionnaire-based survey in written form was conducted.
  
  
  RESULTS
  Altogether 666 persons (51% female) between 18 and 79 years old (mean value: 41,0 years, standard deviation: 11,2 years; median: 41 years) participated in this evaluation, which amounts to a participation rate of 35.5%. The majority of participants stated to refrain from buying prescribed medication (65.2%) as well as from seeking medical advice and paying euro 10.00 own contribution (60.8%) because of their financial situation. The multivariate, binary logistic end-model showed age, family situation, insolvency proceedings, medical conditions and the self-reported attitude towards health alertness to be relevant factors of influence for both target variables.
  
  
  CONCLUSIONS
  The enacted own financial contribution when seeking health care or when receiving medication in Germany might cause a discrimination of indebted persons or households with regard to health care and medical treatment. Because of the obligation of additional payment, health services are not independent of an individual's financial resources, meaning that especially destitution in expenditure affects equal opportunities in the health care system.
authors.affiliation: Institut für Arbeits-, Sozial- und Umweltmedizin der Johannes Gutenberg-Universität Mainz, Mainz. eva.muenster@uni-mainz.de
authors.forename: E
authors.initials: E
authors.lastname: Münster
authors.forename: H
authors.initials: H
authors.lastname: Rüger
authors.forename: E
authors.initials: E
authors.lastname: Ochsmann
authors.forename: C
authors.initials: C
authors.lastname: Alsmann
authors.forename: S
authors.initials: S
authors.lastname: Letzel
mesh_terms: D005382:Financing, Personal / Q000191:economics*; D005858:Germany / Q000453:epidemiology; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000191:economics*; D009313:National Health Programs / Q000706:statistics & numerical data*; D011203:Poverty / Q000191:economics*; D011287:Prejudice; D012959:Socioeconomic Factors