Barely useful additional services at the doctor

Almost all IGEL additional services at the doctor are superfluous and provide little benefit

06/06/2011

More and more doctors offer their patients so-called „Individual health services“, short, IGEL, on. Such additional benefits have now become a lucrative sideline to the doctors. In the last year alone, registered physicians recorded revenues of around 1.5 billion euros. But the special services for treatment and diagnostics are actually useful and they only aim to pull the worried patients out of their pockets?

For several weeks, Birgit S. complains of a slight cough. Compared to her family doctor, Ms. S. declared her concern that she may be suffering from lung cancer because, in addition to the cough, there is also a pain on the chest. The general practitioner could find no abnormalities when listening to the lungs. To alleviate the patient's concern and to be on the safe side, the doctor Birgit S. referred to a lung specialist. Once there Birgit S. went through a series of investigations. „To be really sure that no asthmatic respiratory dysfunction“ is present, one must „perform a nitric oxide NO examination“, said the pulmonologist. But since this investigation is a so-called „IGEL performance“ that is not financed by the health insurance. Therefore, Mrs. S. must pay 20 euros extra. Something like this happens to thousands of patients every day.

1.5 billion euros through additional services
Germany's physicians earned about 1.5 billion euros in private benefits last year. For the current year, the revenue could even increase, as health economists predict. Diagnoses or therapies that provide no actual benefit or are superfluous, pay for the cash register is not a penny. Certain services are only included in the catalog of benefits of the health insurance companies, if indeed a medical added value for the patient is present and scientifically confirmed. Again and again, doctors, patients and health insurance companies argue over the inclusion in the catalog.

Business with the anxiety of the patient
Now, however, the business is thriving with the fear even without reimbursement of health insurance. Whenever patients are concerned about their health, additional benefits can be well sold. Birgit S. finally agreed „NO test“ to. However, in a later research, she noted that although an elevated score demonstrates the presence of an asthmatic respiratory dysfunction, a normal reading does not exclude the presence of bronchial asthma. „Were the 20 euros now completely in vain invested?“, asks Birgit S.

Wide range of IGEL services
The range of additional services offered is wide and ranges from special gynecological services to preventive diagnoses and orthopedic therapies. Most frequently, ultrasound examinations are booked at 20 percent, followed by Grüner Star precautionary diagnoses at 16.2 percent. Non-reimbursable medicines ranked third with 11.5 percent. Meanwhile, more than 300 such IGEL services are offered. Since 2005, the industry has seen a whopping 50 percent increase. According to a study by the scientific institute of the AOK (Wido), already a quarter of those insured under statutory health insurance were offered such a service.

Consumer advocates warn against additional services
Consumer advocates and even representatives of the German Medical Association warn against the inflationary use of IGEL services. Because often these services do not fulfill their purpose and in case of doubt only fill the purse of the attending physician. "The patient is made to the customer, whether he wants it or not," said Stefan Etgeton, an expert at the consumer center in the Federal Association. There is no catalog of benefits for additional health products. There is only the so-called „free market“ stresses Etgeton. This does not mean the benefit is in the foreground, but supply and demand. Due to the economic considerations of the physician, the relationship between doctor and patient is clouded, critics criticize. And the German Medical Association warns: "patients are not customers and the medical profession is not a trade."

Doctors learn sales strategies during training
By far, IGEL offers are no longer marginal. Medical assistants are regularly taught to hold sales talks in trainings. But people do not go to the doctor to buy a product, but because they are sick. Most patients also do not expect an economic interest. After all, as a patient you are not on an equal footing, explains Kai Vogel from the Consumer Affairs Center of North Rhine-Westphalia. "You have to rely on the expertise of the doctor.“ Economic thinking should not play a role here, emphasizes the consumer advocate. A monetary interest should not underestimate patients. Therefore, the Federal Center of Consumer Protection advises in principle to restraint. It would be best to allow yourself to think twice. Because no IGEL performance is vital and would have to be applied to the controller, Vogel emphasizes. Afterwards one can inform oneself sufficiently and then either agree or reject.

Doctors in this context like to claim again and again that certain additional services were included before the health care reform in the catalog of benefits of the health insurance companies. This is not the case with any single IGEL performance and therefore belongs to the category of false claims. Anyone who is pressured or compelled as a patient to acquire an additional benefit or who, in the case of rejection, feels that he should be treated worse, should complain to his health insurance or to the competent medical association. A refusal must not lead to a worse treatment. (Sb)

Also read:
Doctor visit: Beware of additional services
Doctors are selling more and more benefits
Doctors as sellers of additional services

Picture: Paul Golla