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Many countries have a compulsory health insurance system. Compulsory health insurers charge income-related fees as opposed to private health insurers who charge risk-related fees. Compulsory health insurance is based on solidarity among policy holders and can give them more privacy than any private health insurer can. As an example, the present paper considers the German health insurance system, and discusses how the charging and clearing of medical services can be implemented so as to support both the legitimate privacy interests of patients and physicians and the health insurer's interest to control the overall cost. A cryptographic solution is presented that is based on digital patient assistants, that is, personal palmtop computers, organizers or personal digital assistants (PDAs). Patients are, therefore, able to manage their own health insurance certificates, referrals and prescriptions. Although still too expensive for large-scale introduction, digital patient assistants have a number of significant advantages over any chip-card or paper-based system: (1) significantly more efficient and reliable data communication between the various healthcare providers involved in treatment; (2) real patient privacy through direct and off-line communication between digital patient assistants and physicians' practices; and (3) a huge potential to develop telemedicine in a privacy oriented way. Finally, one possible implementation is presented in more detail. The paper also shows how compulsory health insurers can use this solution to control their overall costs. [ABSTRACT FROM AUTHOR]