Panel physicians are increasingly offering individual health services (IHS) to patients with statutory health insurance. This is documented by Susanne Richter et al. of the Department of Social Medicine, Lbeck University, in the new edition of Deutsches rzteblatt (Dtsch Arztebl Int 2009; 106(26): 433-9). IHS include medical health services which are not reimbursed by the health insurance funds and which the patient has to pay for himself.
In February 2007, the authors interviewed a total of 4898 inhabitants of Lbeck and Freiburg/Breisgau aged between 20 and 79 years about their experiences with limitations in health services and IHS. 1899 of the respondents were insured in an official health insurance fund and had visited a doctor during the previous 12 months. More than 20% of this group reported that there were restrictions to services - particularly when visiting orthopedic physicians, GPs and dermatologists. Most of the services refused were medicines or drugsmore rarely rehabilitation measures or aids. More than 40% of the respondents reported that they had been offered IHS in the doctor's practice or that they had enquired themselves. Most of the offers came from ophthalmologists or gynecologists. Measurements of the internal pressure in the eye and ultrasound investigations were most often suggested. The patients' enquiries were about the prescription of medicines, drugs or aids, as well as blood or laboratory tests and services related to travel medicine.
The respondents had a favorable opinion about briefing concerning the costs and benefits of the additional services. There were however deficits related to the explanation of the risks, written information, written contracts on treatment and the possibility of obtaining a second opinion. Some patients said that these offers made them feel nervous, uncertain or under pressure to accept the services. About 43% of the respondents were first refused prescriptions and then offered them as IHS. / RO
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