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Health technology assessment of utilization,practice and ethical issues of self-pay services in the German ambulatory health care setting |
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| Authors: | Theresa Hunger Petra Schnell-Inderst Katharina Hintringer Ruth Schwarzer Vanadin Seifert-Klauss Holger Gothe Jürgen Wasem Uwe Siebert |
| Institution: | 1. Department of Public Health and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060, Hall i.T., Austria 2. Oncotyrol, Center for Personalized Cancer Medicine, Innsbruck, Austria 3. Ludwig Boltzmann Institute for Health Technology Assessment, Vienna, Austria 4. Department of Obstetrics and Gynecology, Technical University Munich, Munich, Germany 5. Institute for Health Care Management and Research, University Duisburg-Essen, Essen, Germany 6. Department of Health Policy and Management, Center for Health Decision Science, Harvard School of Public Health, Boston, MA, USA 7. Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA |
| Abstract: | ObjectivesThe provision of self-pay medical services is common across health care systems, but understudied. According to the German Medical Association, such services should be medically necessary, recommended or at least justifiable, and requested by the patient. We investigated the empirical evidence regarding frequency and practice of self-pay services as well as related ethical, social, and legal issues (ELSI).MethodsA systematic literature search in electronic databases and a structured internet search on stakeholder websites with qualitative and quantitative information synthesis.ResultsOf 1,345 references, we included 64 articles. Between 19 and 53 % of insured persons received self-pay service offers from their physician; 16–19 % actively requested such services. Intraocular pressure measurement was the most common service, followed by ultrasound investigations. There is a major discussion about ELSI in the context of individual health services.ConclusionsSelf-pay services are common medical procedures in Germany. However, the empirical evidence is limited in quality and extent, even for the most frequently provided services. Transparency of their provision should be increased and independent evidence-based patient information should be supplied. |
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