[Health status of spa visitors]

German compulsory health insurance grants outpatient and inpatient prevention and rehabilitation treatments at spa facilities to avoid early retirement and long term care. A survey including participants between the age of 55 and 75 (n = 721) was conducted to determine the extent to which the current granting of spa treatment complies with regulations ("Begutachtungsanleitung Kuren"). The analysis was based on the data provided in the treatment application form by the general practitioners and on the answers of participants to a questionnaire on health-related quality of life (IRES). It compared a) cases granted outpatient/inpatient treatment at spa facilities, b) cases granted prevention/rehabilitation treatments at spa facilities and c) participants in spa treatments and controls from the IRES standard sample. For musculoskeletal diseases and diseases of the connective tissue, outpatient treatment was more often granted than inpatient treatment. There were no differences in the diagnoses of participants in prevention and rehabilitation treatments. Patients complaining about severe impairments/disabilities were granted inpatient rather than outpatient treatment. There were only minor differences between cases granted prevention and rehabilitation treatments respectively. The participants in spa treatment felt more impaired/disabled than controls of the standard sample. Overall, the selection of participants in spa treatment and the referal to outpatient and inpatient and inpatient treatments for the most part follows a needs-based pattern; however, improved differentiation is required between outpatient and inpatient prevention and rehabilitation treatments.