Rip off patients based on a new law

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Patient Protection Act favors rip-off in individual health services (IGeL)

The new patient protection law should come into force in 2013, but criticism of the previous draft is still coming from many sides. The Federal Consumer Association (vzbv) has now called for improvements to the so-called individual health services (IGeL). The current draft of the Patient Protection Act weakens patient rights in individual health services and enables doctors to sell health care services, some of which are extremely controversial, more easily than before, criticize consumer advocates.

"Many doctors take advantage of the trust of the patients when they change from a helper to a salesperson," said Gerd Billen, board member of the Federal Association of Consumer Centers. The consumer protection law believes that this must be prevented by the new patient protection law. The so-called "self-pay services should serve health, not fuel the self-service mentality of some doctors", emphasized Billen. To this end, the Federal Government has made considerable improvements to the previous draft of the Patient Protection Act and the IGeL services should "be subject to stricter rules."

Law to strengthen patient position For years, the introduction of a new patient protection law has been discussed. The role of patients in health care has changed because they are "not only trusting patients, but also self-confident contributors and critical consumers," explains the Federal Ministry of Health on its website on the requirements of a new patient protection law. With the law "the Federal Government now wants to further strengthen the position of patients vis-à-vis service providers and health insurers", the ministry continues. One focus of the law is the regulation of the burden of proof in the event of possible treatment errors. In this way, the possibilities of the patient should be expanded if a treatment error is suspected. However, a general reversal of the burden of proof, in which the treating physicians have to prove that they have not made a mistake, was rejected by both the doctors and the government.

Billions in business with individual health services The interests of doctors are also protected in the current draft of the patient protection law with the regulations on individual health services, while in the opinion of the consumer advocates the patients are clearly neglected. The IGeL are a very rewarding business for the medical profession. With individual health services, they implement “at least 1.5 billion euros annually in Germany,” reports the vzbv. Patients are often not informed in the prescribed manner, influenced by massive advertising, and "in some cases do not even get a contract or an invoice," according to the Federal Association of Consumer Advice Centers, referring to a nationwide online survey from April to June 2012, in which more than 1,700 consumers were involved.

Doctors' sales mentality The survey found that doctors particularly often sell individual health services to patients such as "early glaucoma detection, ultrasound, the PSA test and dental treatments", reports the Federal Consumer Association. Offers such as intraocular pressure measurements, shock wave therapies or autologous blood therapy are increasingly being implemented. A large part of the IGeL (82 percent) did not come about on the initiative of the patients, "although the doctors have made a commitment," writes the vzbv. In around half of all cases, the practice staff was directly involved in the sale, the consumer advocates continued.

Studies prove deficits in the IGeL "The results in patient information were particularly dramatic: only one in four (23 percent) remembered that they were informed about risks," said the Federal Association of Consumer Centers. In addition, only every second patient was informed about the individual benefit. Around a quarter of the patients received no information about the cost of the treatment and 20 percent received an inadmissible invoice for their treatment. A study by the AOK Scientific Institute (WIdo) came to a comparable negative result, in which the data of 3,000 insured persons were evaluated. According to this, around 14 percent of the participants did not receive an invoice for the individual health services; more than half did so without the required written agreement. Also the frequently offered IGeL did rather poorly in a study by the medical service of the central association of health insurance funds (MDS), which means for the insured "to be particularly careful here", MDS managing director Peter Pick explained at the beginning of the year.

Patient protection law may worsen patient situation The new patient protection law offers hardly any improvements here, according to the consumer advocates. According to vzbv expert Ilona Köster-Schneider, the vague wording in the planned legal text could even lead to a worsening of the situation. Even today, doctors can only carry out IGeL under certain conditions. The federal mantle contracts for doctors and the voluntary commitment in the 2011 professional code of practice regulate which requirements must be met for self-pay services. 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 insurers do not perform this service. However, the requirements are obviously not always met.

Definition of information about the benefits of IGeL in the law is necessary. According to consumer protection, it would therefore be urgently necessary to legally fix these basic requirements in the new patient protection law. But instead of the written form, i.e. the contract between patient and doctor, in the law, only the term "text form" is used here, which could also be a simple advertising flyer, criticized the vzbv expert Köster-Schneider. Furthermore, the current draft does not specify the obligation of doctors to provide sufficient information about the benefits of IGeL. According to the criticism of consumer advocates, there is also no information about possible alternatives, which may even be taken over by the health insurers.

Federal government asked to make improvements to the patient protection law Overall, "the current draft of the patient rights law does not achieve the level of protection of the existing legal situation in the professional law of doctors and the voluntary commitment of the 109th day of doctors from 2006", according to the consumer association of the Federal Association. The consumer advocates therefore demanded improvements from the federal government such as the "written information on the benefits and risks of the service, where possible, from the official benefit assessment", a "complete and understandable description of the scope of services", a "complete statement of costs before the service", the "mention possible follow-up costs, for example in the case of side effects of cosmetic surgery ”and the“ mentioning of treatment alternatives by the statutory health insurance funds (GKV) and the circumstances under which reimbursement is provided by the GKV. ”According to the Federal Association of the Consumer Advice Center,“ everyone should have a 24-hour reflection period Types of benefits where the initiative comes from the doctor ”.

Include medically meaningful IGeL in the health insurers' service catalog. In addition, in the opinion of the Federation of German Consumer Organizations, the "written form requirement for the processing" of IGeL must be laid down in the patient protection law as well as the clear "separation of business and care" in medical practices. In the opinion of consumer advocates, a "stricter enforcement obligation for authorities and chambers" should also be anchored in the patient protection law. In addition, medically sensible IGeL should be promptly transferred to the health insurers' service catalog, which would require an acceleration of the method assessment procedures by the Federal Joint Committee (G-BA), according to the position of the Federal Consumer Association. However, it remains to be doubted whether the demands of consumer protectors will still be included in the new patient protection law, since the Federal Ministry of Health has already rejected many criticisms. (fp)

Read on:
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Which IGeL services really make sense
IGeL services at the doctor are often unnecessary
Health insurance companies want to restrict additional services
Doctors as sellers of additional services
Doctor's appointments: health insurance patients are disadvantaged
Hardly any useful additional services at the doctor

Image: Andrea Damm /

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