Individual health services, or IGeL for short, have a bad reputation for being unnecessary or even harmful examinations. Some experts are even calling for a ban on self-payer services.Source: dpa

Banning IGeL – this is what the Federal Government’s Patient Commissioner Stefan Schwartze recently called for for some self-payer services, also known as individual health services, or IGeL for short. If IGeL have no proven benefit and could even be harmful, they should not be allowed to be offered, Schwartze continued.

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Specifically, this involves examples such as ultrasound examination of the ovaries. This enables efficient clarification in the event of symptoms or a suspicion of cancer and is then covered by health insurance companies. However, as a pure early cancer detection without concrete evidence, the examination is an IGeL. “The same method can be unsuitable for the early detection of a disease,” explains Andrea Lichterfeld-Kottner, Head of Evidence-Based Medicine at the Federal Medical Service.
It makes a difference whether you examine a specific symptom or conduct an examination for no reason at all.
Dr. Andrea Lichterfeld-Kottner, Head of Evidence-Based Medicine at the Federal Medical Service

Background information on IGeL

Individual health services are self-payer services that are not covered by health insurance companies.

The Federal Joint Committee (G-BA) decides whether a previous IGeL will be recognized as a statutory health insurance benefit in the future.

Reasons for classification as an IGeL service can be:
  • It is a service that is not medically necessary, such as a justifiable cosmetic procedure or medical advice on long-distance travel.
  • The G-BA has not (yet) made a decision on the service or has refused recognition because it either classifies the benefit of a service as not economical in comparison to its costs or considers the effectiveness of a service as not scientifically proven

According to the Patient Rights Act, you must be informed about the background and costs of an IGeL service before you start receiving it. Consumer associations criticize the fact that this is often inadequate.

Examination does not improve chances of survival

In fact, according to studies, the IGeL “Ultrasound of the ovaries for early detection of cancer” does not improve the chance of survival. “Instead, such random screenings often result in false positive results and thus unnecessary psychological stress and follow-up examinations,” says Michaela Schröder, head of consumer policy at the Federal Association of Consumer Organizations (VZBV). Schröder believes that IGeLs like this are sometimes used to make money, and not always for the benefit of the patient’s health.

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Professional association defends IGeL

Klaus Doubek, President of the Professional Association of Gynecologists, stressed when asked that the profession has committed itself to only offering medically recommended or at least justifiable services. In the practices, ultrasounds are not performed only on the ovaries, but always on the entire pelvis: “This includes several organ structures such as the uterus, fallopian tubes, ovaries, bladder and the interior of the woman’s pelvis.” The association goes on to say that “in 10 percent of cases, an abnormal finding is found in almost 1,000 women.” The examination is therefore a useful addition.

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Take your time to decide

How are patients supposed to see through this? “The most important thing is to avoid being taken by surprise,” says Michaela Schröder. Her tip: take your time with the decision and gather additional information. The so-called IGeL monitor can help with this.

  • The IGeL Monitor, an offer from the Federal Medical Service, supported by the health insurance companies, classifies frequently used IGeL into categories such as “positive”, “tending to be positive”, “tending to be negative” or “negative”.
  • The portal lists scientific evidence on the benefits and possible disadvantages of IGeL.
  • If the study situation is unclear, an IGeL is usually rated as “unclear”.
  • In the case of preventive examinations, unclear study results can sometimes lead to the verdict “tends to be negative”. The reason: possible negative effects such as false positive findings, false security due to false negative findings or overdiagnosis, which lead to unnecessary follow-up examinations.

In addition, legal regulation is also needed, Michaela Schröder continues. “We are currently concerned about the trend that you can sometimes get an appointment more quickly on online portals if you choose the IGeL instead of the statutory health insurance benefit,” says Schröder. There are also repeated patient complaints that treatment is linked to the choice of an IGeL, even if an effective statutory health insurance benefit is available.

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VZBV demands independent information

Schröder is therefore not calling for a general ban on certain IGeLs, but for stricter legal information requirements: “So that patients can make an informed decision.” Specifically, she envisages a mandatory standardized form for each IGeL, which should be created by the independent Institute for Quality and Efficiency in Health Care (IQWIG) and should provide information on effectiveness and costs. It would be conceivable that patients would have to sign this before treatment begins.

  • Actively request information about costs, benefits, risks and alternatives to an IGeL from your doctor’s office – you are legally entitled to this.
  • If it is not urgent: After the doctor’s consultation and before treatment, do some research at home about the relevant IGeL, for example by reading the profile in the IGeL Monitor.
  • If your treatment is not listed in the IGeL Monitor, ask there – perhaps the service is just called something different, or the team will use your query as an impetus for new research.
  • Ask your health insurance company for information about the relevant IGeL. In some cases, there are good alternatives to self-paying services.
Karen Grass is editor of the ZDF magazine WISO.

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