In Germany, patients with SH insurance have the right to request a second medical opinion before specific planned operations. The legal basis for this right is § 27b SGB V.
Every operation also involves risks. In the second opinion process, independent and qualified specialists, therefore, check whether the recommended operation is medically necessary and advise the patient on possible therapeutic alternatives. In addition, the IQWiG prepares scientifically based and independent information material for these procedures in order to support patients in their decision-making.
The G-BA decides which planned procedures are covered by this. The directive for second opinions (Zm-RL) specifies the details and indications for these procedures and who exactly is eligible to provide the second opinions. Currently, the following surgeries are covered in the directive:
- Amputation in diabetic foot syndrome
- Surgery on the tonsils or pharynx (tonsillectomy, tonsillotomy)
- Removal of the uterus (hysterectomy)
- Shoulder arthroscopy
- Implantation of a knee endoprosthesis
- Operations on the spine – since Sep 2021
Operations on the spine
The development of this directive was supported by findings from the innovation funds project DEWI. The systematic analysis of health care showed indications of overuse and incorrect care concerning spinal interventions and diagnostic procedures. For example, the number of certain operations on the spine increased significantly between the years 2006 and 2016. There were also clear regional differences. This increase could not be explained simply by the increase in the disease burden, e.g. due to an aging population. The G-BA considered these observations of the DEWI project in developing the directive.
The directive specifically covers the following operations on the spine:
- dynamic and static stabilization (osteosynthesis and spondylodesis)
- bone pressure relief (decompression)
- facet operations
- procedures for inserting material into a vertebral body
- removal of disc tissue (excision) and
- insertion of an artificial disc (disc endoprosthesis).
Clinicians in the following specialties can give a second opinion before an operation on the spine:
- Orthopedics and trauma surgery
- Orthopedics
- Surgery with a focus on trauma surgery
- Neurosurgery
- Physical and Rehabilitative Medicine
- neurology
- General medicine, internal medicine or anesthesiology (each with the additional designation “special pain therapy”).
This means these clinicians can now apply to the KBV to be approved as a specialist offering second opinions. They can then offer this service with the costs being covered by the SHI funds.
Patients with SHI can find these approved clinicians on the website www.116117.de/zweitmeinung.