Some health experts and patients in Germany are becoming concerned about the increasing frequency with which doctors offer patients inessential diagnostic tests and unproved treatments. They say that these extra services are being offered more to boost doctors' incomes than to help patients.
“These offers put the doctor-patient relationship at risk,” said Jürgen Klauber, director of the Wissenschaftliche Institut der Ortskrankenkassen (Scientific Institute of General Health Insurance).
A survey published last week by the institute, which provides scientific expertise to Germany's largest health insurance company, AOK, has shown that last year about 18 million patients were offered these “Individuelle Gesundheitsleistungen” (“individual health benefits”), commonly shortened to IGeL.
German doctors earned an extra €1bn (£0.7bn; $1.4bn) by selling IGeL, equivalent to almost 5% of the state health insurance budget paid for outpatient care each year in Germany.
The benefits were introduced in the mid-1990s by the National Association of Statutory Health Insurance Physicians as a way of circumventing their tight budgets. Initially there were 79 items, including counselling and vaccination before holidays abroad, as well as some forms of complementary medicine.
However, since then the number of items has increased to more than 300, and because no clear scientific evidence exists for most of them, patients cannot have their cost refunded by the statutory health insurance companies, which cover 90% of Germany's population. Private health insurance companies do cover many of the tests and procedures.
The recent survey, which involved telephone interviews with 3000 AOK customers, showed that specialists were more likely than GPs to offer IGeL. The most common test for sale was extra ultrasound examination in prenatal care, sometimes known as “baby TV.” Health insurance companies will pay only for three such examinations, and expectant mothers wanting more have to pay for them themselves.
Companies offering statutory health insurance will also pay for eye pressure measurements, if glaucoma runs in the patient's family, and some cancer detection tests at certain intervals for women, but they will not pay for a wide range of other tests and procedures, including cosmetic procedures, acupuncture, psychotherapy, the prostate specific antigen test for screening of prostate cancer, tests for fitness and toxicology screening, and help with giving up smoking.
Patients with higher incomes and better education were more likely to be offered IGeL than poorer patients, the survey found.
Many patients, it found, considered that the offer of these benefits threatened the doctor-patient relationship and said that the doctor's commercial interests made them feel uneasy.
Last year the German Medical Association's annual meeting passed a resolution advising that such services should be used seriously and responsibly. However, doctors pointed out at the meeting that at a time of increased rationing in the healthcare system they must be allowed to react to growing demand so they can safeguard their existence and their businesses.
A recent poll of doctors showed that half of them were economically dependent on offering IGeL, and the verb “Igeln” has become a well known term to doctors. Communication trainers and marketing experts offer websites and training in how to introduce IGeL in a practice.
The health insurance companies have reacted by publishing guidelines and advice and offering telephone hotlines to help patients judge for themselves whether these offers are necessary.