Individuelle Gesundheitsleistungen (IGeL) are medical services not covered by German statutory health insurance, requiring patients to pay out-of-pocket. According to the IGeL-Monitor from the Medizinischer Dienst (MD), patients spend at least €2.4 billion annually on these services, many of which lack scientific evidence of benefit or may be potentially harmful.
The Financial Scale and Risks of IGeL Services
Statutory health insurance in Germany covers a specific catalog of treatments. Anything outside this list falls under IGeL. While some services, such as travel vaccinations or specific medical certificates, are considered reasonable, a significant portion of the market is based on scientifically contested methods.
The Medizinischer Dienst Bund reports that orthopedics represent the largest share of this spending, with patients paying roughly €400 million annually for back and knee treatments that often lack proven efficacy. Stefan Lange, an expert for evidence-based medicine at the MD, notes that some services can be actively detrimental. He cites ultrasound screenings for ovarian cancer as a primary example, stating that large studies show a high rate of false-positive results, which can lead to unnecessary surgical removal of the ovaries.
Proposed Protections and Patient Advocacy
Patient advocacy groups and health insurers are calling for stricter regulations to prevent the “sale” of useless medical services during consultations. Thomas Moormann of the Verbraucherzentrale Bundesverband (VZBV) argues for a clear separation between standard medical treatment and the sale of paid add-ons. Moormann suggests that removing these sales pitches from the examination room would free up physician time and potentially reduce patient waiting lists.
Current proposals from health insurers and advocacy groups include:
- Mandatory Reflection Period: A suggested 24-hour waiting period between the offer of an IGeL service and the patient’s decision to pay.
- Transparency Requirements: Stricter rules on how benefits and risks are communicated to the patient.
- Separation of Care: Ensuring that the primary medical consultation remains focused on health rather than commercial transactions.
Federal Government Rejects New Legislation
Despite the warnings from medical experts and consumer protectors, the German federal government currently sees no need for new laws. In a response to a parliamentary inquiry from the Green Party, the Ministry of Health acknowledged deficiencies in how patients are informed about the risks and benefits of IGeL services but rejected a ban on specific treatments.
The government maintains that the responsibility for monitoring these services lies with the respective medical chambers (Ärztekammern). This stance is contested by Green Party health politician Armin Grau, who argues that patients often mistakenly believe IGeL services are superior to those covered by statutory insurance. Grau asserts that the current lack of transparency creates a “false impression” that harms patient decision-making.
Comparing IGeL Costs by Category
| Category | Annual Expenditure (Approx.) | Scientific Standing |
|---|---|---|
| Total IGeL Market | €2.4 Billion+ | Mixed/Contested |
| Orthopedic Services | €400 Million | Often lacks proven benefit |
| Ovarian Cancer Screening | Not specified | High false-positive rate |
Frequently Asked Questions
What exactly is an IGeL service?
IGeL stands for “Individuelle Gesundheitsleistungen.” These are medical examinations or treatments that a doctor offers to a patient, but which are not included in the standard benefit catalog of statutory health insurance. Consequently, the patient must pay for them privately.
Are all IGeL services useless?
No. According to Stefan Lange of the MD, there are “reasonable” IGeL services, such as specific vaccinations or official medical certificates, that provide clear value to the patient.
How can I tell if an IGeL service is necessary?
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