title: Health technology assessment of utilization, practice and ethical issues of self-pay services in the German ambulatory health care setting.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  A systematic literature search in electronic databases and a structured internet search on stakeholder websites with qualitative and quantitative information synthesis.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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, t.hunger@umit.at.
authors.forename: Theresa
authors.initials: T
authors.lastname: Hunger
authors.forename: Petra
authors.initials: P
authors.lastname: Schnell-Inderst
authors.forename: Katharina
authors.initials: K
authors.lastname: Hintringer
authors.forename: Ruth
authors.initials: R
authors.lastname: Schwarzer
authors.forename: Vanadin
authors.initials: V
authors.lastname: Seifert-Klauss
authors.forename: Holger
authors.initials: H
authors.lastname: Gothe
authors.forename: Jürgen
authors.initials: J
authors.lastname: Wasem
authors.forename: Uwe
authors.initials: U
authors.lastname: Siebert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000706:statistics & numerical data; D017047:Cost Sharing; D005382:Financing, Personal / Q000941:ethics / Q000706:statistics & numerical data; D005858:Germany; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008875:Middle Aged; D011787:Quality of Health Care; D055815:Young Adult
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