title: Individual health services and the denial of health services in German medical practices: prevalence, regional differences and socio-demographic determinants.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Institute for Social Medicine, University at Lübeck, 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: D000328:Adult; D000368:Aged; D003625:Data Collection; D005260:Female; D005858:Germany; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D016079:Refusal to Treat / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult