LNSLNS The private or so-called second-tier healthcare market indisputably offers great opportunities in terms of financial gains.

It is understandable that doctors want their slice of the cake by means of offering individual health services. The authors in their article provide important data about how persons with statutory health insurance (SHI) experience this situation. In order to be financially successful, doctors cannot afford to be too soft—45% of the patients are being offered to purchase individual medical services privately that they were previously denied in the context of their insurance scheme. Even the fact that most of the services offered in this way are controversial or even superfluous (an example worth mentioning has given rise to the discussion regarding the benefits of measuring prostate specific antigen [PSA]) shows the fundamental change in the relationship between doctors and patients that is emerging. A proportion of doctors seem to be unaware that they are in a situation that is historically unique. Thanks to social security insurance schemes, it is possible for medically indicated diagnostic tests and treatments to be offered independently of a patient’s income. Those of a reasonably cynical mindset might detect a return to the type of medicine that has been practiced throughout most of history: income dependent medicine.

The recommendation of the German Medical Association that patients should not be downgraded to customers/clients, even in the face of the many unnecessary services on offer, expresses a certain amount of naivety, as one glance at the relevant publications will confirm. If, for example, the whole practice team is involved in delivering individual health services, the underlying approach of profit maximization is hard to conceal. Each and every doctor should ask themselves whether short term financial gain justifies the deep-seated erosion of the relationship of trust between themselves and their patients.

If “service providers” is today’s only buzz word, and if financial interests in health policy are increasingly perceived as the main priority, then the professional class that is doctors should consider carefully whether they are willing to support this trend towards economizing.
DOI: 10.3238/arztebl.2010.0008a

Dr. med. Johannes Gossner
Wittekamp 1
30177 Hannover, Germany
johannesgossner@gmx.de
1.
Richter S, Rehder H, Raspe H: Individual health services and the limits to service provision in insurance registered german medical practices—patient experiences [Individuelle Gesundheitsleistungen und Leistungsbegrenzungen – Erfahrungen GKV-Versicherter in Arztpraxen]. Dtsch Arztebl Int 2009; 106 (26): 433–9. MEDLINE
1. Richter S, Rehder H, Raspe H: Individual health services and the limits to service provision in insurance registered german medical practices—patient experiences [Individuelle Gesundheitsleistungen und Leistungsbegrenzungen – Erfahrungen GKV-Versicherter in Arztpraxen]. Dtsch Arztebl Int 2009; 106 (26): 433–9. MEDLINE