Patient rip-off based on a new law

Patient Protection Act favors rip-offs for individual health services (IGeL)

16/10/2012

The new Patient Protection Act is due to come into force in 2013, but there are still many criticisms of the previous draft. Now, the Verbraucherzentrale Bundesverband (vzbv) has called for improvements in the so-called individual health services (IGeL). The current draft of the Patient Protection Act weakens the patients' rights in the individual health services and allow physicians even easier than before to sell the sometimes highly controversial health services, criticize the consumer advocates.

„Many doctors take advantage of patients' trust when they turn from helper to salesman“, said Gerd Billen, CEO of the Federation of Consumer Organizations. This must prevent the new patient protection law in the opinion of the consumer advocates. The so-called „Self-payer benefits are meant to serve the health, not to fuel the prostate mentality of some physicians“, emphasized Billen. For this purpose, the Federal Government had to make considerable improvements to the previous draft of the Patient Protection Act and the IGeL benefits should be „subject to more stringent rules.“

Law should strengthen the position of patients
For years, the introduction of a new law on patient protection has been discussed. The role of patients in health care has changed because they are „no longer just trusting patients, but also self-confident contributors and critical consumers“, explains the Federal Ministry of Health on its website about the requirements of a new Patient Protection Act. By the law „Now the federal government wants to further strengthen the position of patients towards health care providers and health insurance companies“, so the ministry continues. One focus of the law is the regulation of the burden of proof of possible treatment errors. Thus, the possibilities of patients are suspected of a treatment error to be expanded. A general reversal of the burden of proof, in which the treating physicians have to prove that they did not make a mistake, was rejected by both the doctors and the Federal Government.

Billions Business with Individual Health Services
The provisions on individual health services also safeguard the interests of physicians in the current draft of the Patient Protection Act, while in the opinion of the consumer advocates, the patients are clearly neglected. For the medical profession, the IGeL are quite a worthwhile business. They use individual health services „in Germany annually at least 1.5 billion euros“, reports the vzbv. The patients would often not be informed in the prescribed manner, influenced and maintained by massive advertising „in some cases not even a contract or an invoice“, according to a statement from the Federal Association of Consumer Organizations, citing a nationwide online survey from April to June 2012, in which more than 1,700 consumers were involved.

Sales mentality of doctors
The survey has revealed that physicians like the patient especially often Individual health services „glaucoma early detection, ultrasound, the PSA test and dental treatments“, reports the Verbraucherzentrale Bundesverband. Even offers such as intraocular pressure measurements, shock wave therapies or the self-blood therapy would be increasingly implemented. A large part of the IGeL (82 percent) had not come about at the initiative of the patients, „although a commitment of the doctors provides for this“, writes the vzbv. In about half of all cases, the practice staff was directly involved in the sale, so the consumer advocates on.

Studies show deficits in the IGeL
„Particularly dramatic were the results in the patient education: Only one in four (23 percent) remembered that he was informed about risks“, This is the message of the Federal Association of Consumer Affairs. In addition, only every second patient was informed about the individual benefit. In about a quarter of the patients, no information was provided about the cost of the treatment and 20 percent received an improper invoice for their treatment. A study by the Scientific Institute of the AOK (WIdo), in which the data of 3,000 insured persons were evaluated, came to a similarly negative result. Thus, about 14 percent of the participants for the individual health care services did not receive, more than half took place without the required written agreement. Also cut the frequently offered IGeL in a study by the Medical Service of the Central Association of Health Insurance (MDS) rather bad, which meant for the insured, „be extra careful here“, MDS CEO Peter Pick explained earlier this year.

Patient protection law may worsen the patient's situation
The new patient protection law offers hardly any improvements here, according to the opinion of the consumer advocates. According to the vzbv expert Ilona Köster-Schneider, the vague formulations in the planned text could even lead to a worsening of the situation. Even today, doctors are only allowed to perform IGeL under certain conditions. The Federal Coatings Agreements for physicians and the voluntary commitment in the occupational code of physicians passed in 2011 regulate which requirements must be fulfilled for self-payers. Thus, a written treatment contract and written information about the expected fee according to the medical fee schedule (GOÄ) would be required. Patients should also be informed that the health insurances do not pay for this benefit. The conditions are apparently not always met.

Determination of information about the benefits of IGeL required in law
A legal codification of these basic requirements in the new Patient Protection Act would therefore be urgently required, according to consumer advocates. But instead of fixing the written form, ie the contract between patient and doctor, in the law, this is just the term „writing“ which could also be a simple flyer, the vzbv expert Köster-Schneider criticized. Furthermore, the current draft does not specify the doctors' obligation to provide sufficient information about the benefits of the IGeL. An explanation of possible alternatives, which might even be taken over by the coffers, is not included, so the criticism of consumer advocates.

Federal Government to improve the patient protection law asked
Overall reach „the current draft of the Patients' Rights Act does not reflect the level of protection of the existing legal position in the professional law of physicians and the voluntary commitment of the 109th Medical Day from 2006“, so the assessment of the Verbraucherzentrale Bundesverband. The consumer advocates therefore demanded from the federal government improvements such as the „Written information on the benefits and risks of the benefit, where possible, from the official benefit assessment“, a „complete and understandable description of the scope of services“, a „complete cost statement before service provision“, the „Mention of possible follow-up costs, for example in the case of side effects of cosmetic surgery“ and the „Mention of treatment alternatives of the statutory health insurances (GKV) and the circumstances, under which a reimbursement by the GKV takes place.“ Also should the Federal Association of Consumer Center According to a „24 hours for all kinds of benefits where the initiative comes from the doctor“ be determined.

Include medically meaningful IGeL in the catalog of benefits of health insurance companies
In addition, in the opinion of the Verbraucherzentrale Bundesverbandes the „Written form requirement for the settlement“ the IGeL in the Patient Protection Act as well as the clear „Separation of business and supply“ in the doctor's offices. Also, in the opinion of the consumer advocates a „Stricter enforcement obligations at authorities and chambers“ in the Patient Protection Act. In addition, medically reasonable IGeL should be promptly transferred to the catalog of benefits of the health insurance companies, which makes an acceleration of the method evaluation procedures by the Joint Federal Committee (G-BA), the position of the Verbraucherzentrale Bundesverband. Whether the demands of consumer advocates are still included in the new Patient Protection Act remains to be doubted, as the Federal Ministry of Health has already rejected many criticisms. (Fp)

Read about:
Professional teeth cleaning without benefit?
Which IGeL services really make sense
IGeL services often unnecessary at the doctor
Health insurance companies want to restrict additional benefits
Doctors as sellers of additional services
Doctor appointments: Cash patients are disadvantaged
Barely useful additional services at the doctor

Picture: Andrea Damm