Additional medical services need patient benefit, not sales pressure

A self-pay service is not automatically an unnecessary service

Individual health services are often judged in sweeping terms: either as a necessary addition to a limited benefits catalogue or as a commercial sales instrument. Neither view is sufficient.

Not every clinically useful service is covered by Germany's statutory health insurance system. Conversely, a service is not useful merely because it is technically available and can be paid for privately.

Every additional service therefore needs to answer the same fundamental questions: Which problem is the service intended to detect or treat? What benefit might it offer this patient? Which risks and alternatives exist? What consequence would follow from the result? Only then should the economic question be addressed.

The legal requirements are clear

Treating professionals must explain the material circumstances of treatment in an understandable way. If it is apparent that a third party will not cover the costs in full, the patient must be informed in text form about the anticipated costs before treatment begins.

The information provided for consent must cover, among other things, the nature, extent and implementation of the measure, its consequences and risks, and its necessity, urgency, suitability and prospects of success. If several customary and equally suitable methods involve substantially different burdens, risks or prospects of success, those alternatives also need to be discussed.

For an individual health service provided to a person with statutory insurance, a written private treatment agreement is also required before the service is delivered. The subsequent invoice must be transparent under the German fee schedule for physicians. This is a general professional perspective, not legal advice.

The relationship of trust changes the sales situation

A patient in a medical practice is not making an ordinary consumer decision. The patient is seeking clinical guidance and usually cannot assess the professional significance of an examination independently.

When a paid service is recommended, it can easily create the impression that declining it may endanger the patient's health or adversely affect further treatment. Time pressure, artificial scarcity, emotional escalation and performance-related sales incentives therefore have no place in medical advice.

A patient must be able to decline an additional service without fearing disadvantages. That freedom must not only exist legally; it must be evident in the conversation.

Criticism of individual health services needs to be taken seriously

The Medical Service of the German Federal Association's 2024 IGeL Report estimates that people with statutory insurance spend at least EUR 2.4 billion per year on individual health services. For ophthalmology, the report identifies approximately EUR 544 million in annual IGeL revenue.

At that time, the IGeL Monitor listed 56 scientific assessments: none positive, three tending positive, 23 unclear, 26 tending negative and four negative. These results concern the services assessed and must not be applied indiscriminately to every privately funded ophthalmic service. They nevertheless reveal a substantial problem of trust and information.

Technical diagnostics can appear particularly objective to patients. Yet an examination without a clear indication may generate ambiguous or incidental findings and lead to further tests, uncertainty and costs. Limitations and possible disadvantages therefore also need to be explained.

Benefit needs an individual explanation

A general statement such as 'this examination is useful' is not enough. The patient should understand why the service is being offered in this particular situation, for example because of an individual risk profile, a notable medical history or a specific diagnostic question.

It is equally important to explain what the examination cannot do. It may provide additional information without reliably excluding a disease or predicting its course. Good advice therefore explains not only the technical possibilities, but the actual gain in relevant knowledge.

The question of consequences is decisive

Before any additional examination, two questions should be answered: What will we do differently if the result is abnormal? And what will we do differently if it is normal?

If the result is unlikely to have any clinical or organizational consequence, the benefit is questionable. This question protects against diagnostics that generate information but have no clear meaning for subsequent care.

Staff may provide information, but should not face sales pressure

Medical assistants can provide information about the process, costs and organizational questions. The individual clinical indication and information about benefits, risks and alternatives remain physician responsibilities.

A problem arises when staff performance or compensation is linked to sales figures. This creates a conflict of interest that the patient cannot see. Personal commissions for individual medical services should therefore be avoided.

Pricing needs to be understandable

Patients need to know the costs before the service is provided. For more extensive treatments, it should also be clear which follow-up services are included and which services may incur additional charges.

Unclear pricing not only causes complaints; it damages trust in the clinical recommendation. The invoice must not be the first complete explanation of the costs.

Economic objectives may be stated openly

A practice also needs to manage privately funded services sustainably. Equipment, staff time and rooms create costs. It is legitimate to calculate a price that allows the service to be delivered responsibly.

What would not be legitimate is adapting the clinical indication to a revenue target. The clinical decision answers whether a service should be offered. The business calculation answers at what price it can be delivered responsibly. That sequence must not be reversed.

Conclusion

Additional medical services are not inherently wrong. They can provide useful diagnostic or therapeutic options that are not part of statutory health insurance coverage.

Their legitimacy depends on a transparent individual benefit, understandable information and genuine voluntariness. Patient advice is not a sales event. A good practice needs to operate sustainably, but it must never treat trust as a sales resource.