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Individual health services.

Petra Schnell-Inderst¹, Theresa Hunger, Katharina Hintringer

¹Institute of Public Health, Medical Decision Making and Health Technology Assessment, Dept. of Public Health and Health Technology Assessment, UMIT - University for Health Sciences Medical Informatics and Technology, Hall i.T., Austria.

GMS Health Technology Assessment

|October 4, 2011

Summary

This summary is machine-generated.

Individual health services (IGeL) are common in German healthcare, but evidence for their effectiveness is limited. Glaucoma screening lacks proven patient benefit, and ovarian cancer screening via VUS leads to over-diagnosis and unnecessary procedures.

Keywords:

Doctor's duty to give patients information EBM Federal Joint Commitee HTA HTA report HTA-report Peer review VUS accident add-on benefit additional benefit appropriateness benefit package biomedical technology assessment care catalogue of benefits catalogue of services clinical freedom clinical trials as topic co-payment commercialisation commercialization controlled clinical trials as topic cost analysis cost control cost effectiveness cost reduction cost repayment cost-benefit analyses cost-cutting cost-effectiveness costs costs and cost analysis decision making demand diagnosis economic aspect economics economics, medical effectiveness efficacy efficiency endometrial neoplasms endometrial neoplasms/economics ethics evaluation studies as topic evidence based medicine fee schedule freedom of therapy glaucoma glaucoma/economics health care costs/*health care costs/*ethics health care costs/*standards health economic studies health economics health insurance fund health technology assessment humans individual health services insurance benefits insurance, health, reimbursement/*interview interviews as topic juricical mass screening medical assessment medical costs medical evaluation meta analysis as topic methods obligation to pay obligation to render services obligation to supply services offer physician-patient relations/*ethics poll prevention preventive benefits preventive services private health insurance private service random random allocation randomisation randomization randomized controlled trials as topic range of benefits reimbursement of costs report return of costs review review literature review literature as topic risk assessment screening screening for glaucoma self retention sensitivity social economic factors socioeconomic factors socioeconomics specifity statutory health insurance supplementary benefit survey systematic review technical report technology technology assessment technology assessment, biomedical technology evaluation technology, medical therapy treatment vaginal ultrasound

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Area of Science:

Health Services Research
Medical Ethics
Health Economics

Background:

German statutory health insurance (GKV) covers medically sufficient, appropriate, and efficient services.
Individual health services (IGeL) are patient-requested, out-of-pocket services not covered by GKV.
IGeL encompass a range of services, raising questions about their evidence base and ethical implications.

Purpose of the Study:

To evaluate the empirical evidence on IGeL offers, utilization, practice, acceptance, and economic relevance.
To analyze the ethical, social, and legal aspects of IGeL.
To assess the clinical effectiveness of glaucoma screening and vaginal ultrasound (VUS) screening for ovarian and endometrial cancer.

Main Methods:

Systematic literature review of primary studies and publications on ethical, social, and legal aspects.
Rapid assessments of clinical effectiveness for glaucoma and VUS screening.
Searched HTA-reports, systematic reviews, and original studies for effectiveness data.

Main Results:

19-53% of GKV members receive IGeL offers, with high realization rates.
Intraocular tension measurement and ultrasound assessments are common IGeL services.
No randomized controlled trials (RCTs) show patient-relevant benefit for glaucoma screening; VUS screening shows high over-diagnosis rates and leads to invasive procedures.

Conclusions:

IGeL represent a significant component of the German healthcare system.
Increased transparency and evidence-based patient information are needed for IGeL.
Further examination of positive/negative lists and broader healthcare system reforms are suggested.