Institute for Social Medicine, University at Lübeck, Lübeck, Germany.
Eur J Public Health. 2011 Aug;21(4):491-8. doi: 10.1093/eurpub/ckp145. Epub 2009 Oct 12.
Internationally, in many healthcare systems financial pressure has led to the implementation of co-payments, private medical (extra) services and rationing. In Germany, members of statutory health insurances (SHIs) increasingly report the denial of medical services and the offer/demand of privately financed supplementary health services individual health services, (IHSs) in medical practices. The public discussion on both denial and IHSs is chequered, mainly critical, partly polemic. The present study aims to operationalize IHSs and denial and investigates their occurrence, socio-demographic determinants within two regional populations.
Two postal surveys were conducted in 4898 German inhabitants of Lübeck (Northern Germany) and Freiburg (Southern Germany), aged 20-79 years. The survey focused on experiences with IHSs and denial of health services in medical practices among members of SHIs.
In all members of SHIs that had consulted a physician during the past 12 months (n =1899), the one-year-prevalence of IHSs and denial of medical services were 41.7 and 20.5%. About 40% were offered a denied medical service as an IHS later.
The study presents population-based, quantitative data on IHSs and denial of medical services in German practices. The results partly confirm former findings on the occurrence of IHSs. Contrary to other studies, socio-demographics seemed to play a minor role in the offer/demand of IHSs.
在许多医疗保健系统中，国际上的财政压力导致了共同支付、私人医疗（额外）服务和配给的实施。在德国，法定健康保险（SHI）的成员越来越多地报告医疗服务被拒绝，以及在医疗实践中提供/需求私人融资的补充健康服务（IHS）。关于拒绝和 IHS 的公开讨论参差不齐，主要是批评性的，部分是有争议的。本研究旨在使 IHS 和拒绝服务具体化，并在两个地区人群中调查其发生情况、社会人口统计学决定因素。
在吕贝克（德国北部）和弗赖堡（德国南部）的 4898 名 20-79 岁的德国居民中进行了两次邮寄调查。该调查侧重于 SHI 成员在医疗实践中使用 IHS 和拒绝医疗服务的经验。
在过去 12 个月内咨询过医生的所有 SHI 成员（n=1899）中，IHS 和医疗服务拒绝的一年患病率分别为 41.7%和 20.5%。大约 40%的人后来被提供了被拒绝的医疗服务作为 IHS。
该研究提供了基于人群的、关于德国实践中 IHS 和医疗服务拒绝的定量数据。结果部分证实了以前关于 IHS 发生的发现。与其他研究不同，社会人口统计学因素似乎在 IHS 的提供/需求中作用较小。
