title: Individual health services and the limits to service provision in insurance registered German medical practices: patient experiences.
abstract: BACKGROUND
  Persons with statutory health insurance (SHI) in Germany increasingly report being denied medical services and being asked to purchase individual health services (IHS). We performed a population-based survey to study the prevalence of this practice, patients' attitudes toward it, and any potential regional differences.
  
  
  METHODS
  Systematic samples were drawn from the population registries of Lübeck and Freiburg. First, a postal screening survey explored the one-year and lifetime prevalence of IHS and medical service denial among 2448 persons in Lübeck and 2450 in Freiburg. In a second postal survey, the 915 SHI respondents reporting IHS and/or service denial in the past year were asked for further details of their experiences.
  
  
  RESULTS
  The response rates were 53.2 % (screening survey) and 75.4 % (detailed questionnaire); more persons responded in Lübeck than in Freiburg, and women and older persons responded more commonly than men and younger persons. There was no regional difference in prevalence. Among the 1899 members of SHI that had consulted a physician in the past year, 41.7 % said they had been offered IHS, and 20.5% reported being denied medical services. In this group, 43.3% later had the denied service offered to them as an IHS.
  
  
  CONCLUSIONS
  These population-based data on IHS and the denial of medical services in German medical practices confirm and extend the findings of earlier studies.
authors.affiliation: Universität zu Lübeck, Institut für Sozialmedizin, Lübeck, Germany. susanne.richter@uk-sh.de
authors.forename: Susanne
authors.initials: S
authors.lastname: Richter
authors.forename: Heinke
authors.initials: H
authors.lastname: Rehder
authors.forename: Heiner
authors.initials: H
authors.lastname: Raspe
mesh_terms: D003258:Consumer Behavior / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D009313:National Health Programs / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D012042:Registries