LNSLNS We thank your correspondent for his critical analysis of the potential effects of individual health services, many aspects of which we fully agree with. Any interpretation of the fact that 45% of the patients are offered to purchase privately a previously denied medical service as an individual health service does, however, need to consider the interpretation of what constitutes a denied medical service. On the one hand, some denials of medical services are required as per the catalogue of services that are actually covered by the statutory health insurers. On the other hand, it is entirely possible that some patients have misinterpreted even the mere mention of a private, individual health service as a denial of a medical service covered by their insurance scheme. This question cannot be answered conclusively by means of our postal questionnaire survey.

The spectrum of individual health services mentioned ranges from beneficial treatments (such as malaria prophylaxis) to controversial examinations (PSA screening) to wellness medicine (anti-ageing) and to measures whose benefits have not been proven (ozone therapy/UV irradiation of the blood), which makes for a mix that is not transparent for patients. The absence of evidence based, transparent, and accessible catalogues of services provided by statutory insurers as well as the individual health services makes it difficult for patients to critically assess any denied services, as well as those on offer. Some descriptive studies have implied a correlation of income and independent health services; however, multivariate analyses in our own study have not confirmed such a correlation (1). On the background of financial incentives, such as independent health services offer for doctors and practice staff, potential conflicts of interests arise that affect the trust in the doctor-patient relationship, but also the statutory health insurance funds, which are jointly funded by all their members (2). This situation might be remedied by providing patient oriented information on individual health services, which should be independently compiled on the basis of the scientific evidence, which can be easily understood by laypersons, and which is made freely available. For at least some of the individual health services primarily exist thanks to “insufficient information given to interested parties” (3).
DOI: 10.3238/arztebl.2010.0008b

Dr. rer. hum. biol. Dipl.-Psych. Susanne Richter
Universitätsklinikum Schleswig-Holstein
Institut für Sozialmedizin
Campus Lübeck
Ratzeburger Allee 160 (Haus 50)
23538 Lübeck, Germany
susanne.richter@uk-sh.de

Conflict of interest statement
The authors of both letters declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
1.
Richter S, Rehder H, Raspe H: Individual health services and the denial of health services in German medical practices: prevalence, regional differences and socio-demographic determinants. Eur J Public Health 2009. doi:10.1093/eurpub/ckp145 MEDLINE
2.
Raspe H: Individuelle Gesundheitsleistungen in der vertragsärztlichen Versorgung: eine medizinethische Diskussion. Ethik Med 2006: 18: 1–15.
3.
Windeler J: Interessenskonflikte und Qualitätsmängel bei Individuellen Gesundheitsleistungen (IGeL). In: Verbraucherzentrale Nordrhein-Westfalen (ed.): Markttransparenz im Gesundheitswesen. Beiträge zu einer kontroversen Diskussion. Düsseldorf 2008: Verbraucherzentrale NRW e.V.: 75–84.
4.
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 denial of health services in German medical practices: prevalence, regional differences and socio-demographic determinants. Eur J Public Health 2009. doi:10.1093/eurpub/ckp145 MEDLINE
2. Raspe H: Individuelle Gesundheitsleistungen in der vertragsärztlichen Versorgung: eine medizinethische Diskussion. Ethik Med 2006: 18: 1–15.
3. Windeler J: Interessenskonflikte und Qualitätsmängel bei Individuellen Gesundheitsleistungen (IGeL). In: Verbraucherzentrale Nordrhein-Westfalen (ed.): Markttransparenz im Gesundheitswesen. Beiträge zu einer kontroversen Diskussion. Düsseldorf 2008: Verbraucherzentrale NRW e.V.: 75–84.
4. 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