For more health justice

How can local authorities provide better care for people without health insurance? This question was the focus of a meeting of around 30 representatives from local authorities, health and social services, civil society organisations and research, which took place at Fulda University of Applied Sciences on 21 and 22 January 2026. The aim was to exchange ideas on successful municipal approaches to providing care for people without health insurance.

The symposium began the evening before with a keynote speech by associate lecturer Dr Henrik Lebuhn from Humboldt University in Berlin. He presented the concept of "urban citizenship" and emphasised: "Belonging and participation should be defined by the place of residence, not by nationality." Using international examples of so-called "sanctuary cities", he showed how local authorities can utilise the scope for action that passes.

In his presentation at the official start of the conference, a representative of the Federal Association for Anonymous Treatment Certificates (BACK) emphasised the law on health as a universal human right and allocated the need for sustainable, nationwide structural solutions. The symposium, chaired by Professor Dr Ilker Ataç, was organised by the Centre of Research for Society and Sustainability (CeSST) at Fulda University of Applied Sciences and the German Institute for Interdisciplinary Social Policy Research (DIFIS) in collaboration with Ärzte der Welt e.V. and BACK.

Success stories from nine cities

The exchange of experiences made it clear that municipalities in Germany have developed different approaches to closing structural gaps in care. Cities such as Munich, Cologne, Stuttgart, Frankfurt, Berlin, Hamburg, Leipzig, Münster and Essen presented their models. These range from clearing centres, which advise people without health insurance and refer them to standard care, to anonymous treatment vouchers and municipal health funds. Social workers play a central role in the clearing centres in particular. They advise people in complex life situations, mediate in care systems and develop individualised solutions - often at the interface between the health system, social law and migration.

Despite the local commitment, there is a fundamental problem: "Local authorities are currently compensating for a systemic failure at federal level," emphasised Carolin Bader from Doctors of the World. "It was very impressive to see the commitment and the diversity of offers provided by municipal structures. At the same time, it is frightening to see how differently the capacities for providing care to people without health insurance are distributed across Germany. They often have to stop at city limits. A nationwide solution for a better care and financing structure should therefore continue to be the goal."

The participants are calling for regular funding for clearing centres, clear legal regulations and ensuring that everyone is required to have health insurance.

They discussed key challenges in three working groups: sustainable funding and the long-term anchoring of offers in the municipal budget, follow-up care after hospitalisation and better accessibility for vulnerable target groups such as pensioners without health insurance, children, pregnant women and homeless people in need of care.

"The exchange in the working group was the most valuable, as concrete problems and solutions were reported here that we only came across in open dialogue and that could not be named in this way in a presentation," reported one participant. Another participant added: "I took away a lot of ideas - from cooperation agreements with clinics based on the Mainz model to clarifying the question of taking over contribution debts from the health fund."

Civil society and local authorities working hand in hand

The conference made it clear that successful municipal models are the result of close collaboration between municipalities and civil society. "Civil society actors are often pioneers who identify gaps in care and develop initial, particularly low-threshold solutions. Municipalities benefit when they transfer this expertise into systematic structures," explained Professor Dr Ilker Ataç. Fulda University of Applied Sciences and DIFIS see themselves as bridge builders: "Our role is to moderate the exchange, systematically process experiences and support local authorities in the further development of their offers."

Exchange continues: digital formats and network planned

The participants signalled their interest in taking part in a regular exchange format. Regular digital themed cafés (every 3 to 4 months), an online database with examples of good practice, a newsletter and annual face-to-face conferences are planned. "The municipalities want to learn from each other - continuously, not just once a year," says Professor Ataç. "We will develop these formats together with the participants."

Academic contact:

Professor Dr Ilker Ataç 
ilker.atac@sw.hs-fulda.de