Department of Public Health and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard Wallnoefer Center I, 6060, Hall i.T., Austria,
Int J Public Health. 2014 Feb;59(1):175-87. doi: 10.1007/s00038-013-0494-x. Epub 2013 Aug 1.
The provision of self-pay medical services is common across health care systems, but understudied. According to the German Medical Association, such services should be medically necessary, recommended or at least justifiable, and requested by the patient. We investigated the empirical evidence regarding frequency and practice of self-pay services as well as related ethical, social, and legal issues (ELSI).
A systematic literature search in electronic databases and a structured internet search on stakeholder websites with qualitative and quantitative information synthesis.
Of 1,345 references, we included 64 articles. Between 19 and 53 % of insured persons received self-pay service offers from their physician; 16-19 % actively requested such services. Intraocular pressure measurement was the most common service, followed by ultrasound investigations. There is a major discussion about ELSI in the context of individual health services.
Self-pay services are common medical procedures in Germany. However, the empirical evidence is limited in quality and extent, even for the most frequently provided services. Transparency of their provision should be increased and independent evidence-based patient information should be supplied.
自费医疗服务在各国医疗体系中都很常见，但研究却相对较少。根据德国医师协会的规定，此类服务应该具有医学必要性、被推荐或至少是合理的，并且是由患者要求提供的。我们调查了有关自费服务的频率和实践以及相关伦理、社会和法律问题（ELSI）的经验证据。
在电子数据库中进行系统文献检索，并在利益相关者网站上进行结构化的互联网搜索，以获取定性和定量信息综合分析。
在 1345 篇参考文献中，我们纳入了 64 篇文章。19%至 53%的参保人收到了医生提供的自费服务；16%至 19%的人主动要求提供此类服务。眼压测量是最常见的服务，其次是超声检查。在个体医疗服务方面，人们对 ELSI 进行了广泛的讨论。
自费服务是德国常见的医疗程序。然而，即使是最常提供的服务，其经验证据在质量和范围上也存在局限性。应该提高其提供的透明度，并提供独立的基于证据的患者信息。
