Individuelle gesundheitsleistungen in der vertragsärztlichen versorgung: Eine medizinethische diskussion

Definition of the problem: Within Germany's statutory health insurance system Individual health services are offered (by physicians) or demanded (by patients) with increasing frequency establishing a "second health market". The services come from a wide and heterogeneous spectrum including highly beneficial and evidence-based methods (malaria prophylaxis), so far questionable (sputum cytology) or probably beneficial (osteodensitometry in high-risk populations) screening methods, dubiousand untested methods fromthe field of alternative and complementary medicine and various services to enhance beauty, fitness or wellness. The services are not, as a common characteristic, part of Germany's official health care offer and have to be paid foron a strictly private basis. Arguments: This article discusses chances and risks of the development within a normative framework and addresses five questions.How does selling and buying of "individual services" affect the traditional role of physicians, the identification of useful medical methods and services, our understanding of medicine and its goals, the traditional role of patients, the doctor-patient relationship and our understanding of the German statutory health insurance system? Conclusion: Individual health services are for various and heterogeneous reasons attractive for both patients and doctors. Whereas medicine becomes more and more regulated, they seem to increase the degrees of freedom and range of options of each side. The services may however profoundly change the role and perception of the medical profession within a collectively financed health care system. Whether the second health care market can be effectively controlled and itself regulated is at present an open question.