Copayments in the German Health System - Do They Work?

Abstract

Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Abstract This paper examines the effect of copayments on doctor visits using the German health care reform of 2004 as a natural experiment. In January 2004, copayments of 10 euros for the first doctor visit in each quarter have been introduced for all adults in the statutory health insurance. Individuals covered by private health insurance as well as youths have been exempted from these copayments. We use them as control groups in a difference-in-differences approach to identify the causal impact of these copayments on doctor visits. In contrast to expectations and public opinion our results indicate that there are no statistically significant effects of the copayments on the decision of visiting a doctor. Terms of use: Documents inJEL classification: I11, I18

An Econometric Model of Health Care Demand with Non-Linear Pricing

“…While the results thus are in line with those of two earlier studies by Augurzky et al (2006) and Schreyögg and Grabka (2010) who also found no effect of the co-payment on utilization, the new methodological approach of this paper offers a number of additional insights that might prove useful for future research in related contexts. For instance, the perspective of a stochastic process is useful to understand that any changes to the first hazard likely also affects the distribution of additional visits, simply because it changes the time left in the quarter to accumulate such visits.…”

“…One therefore would expect that the probability of visiting a doctor at least once within a quarter should have fallen in the SHI population relative to the unaffected PHI population. By the same token, one might think that the number of doctor visits for those with at least one visit (the conditional-on-positives or intensive margin effect) should be unrelated to the co-payment (see Augurzky et al, 2006, for such a view) although our analysis below will provide reasons why this is not necessarily the case.…”

“…A number of researchers have conducted quantitative evaluations of the effect of that reform on overall demand and demand at the extensive margin (Augurzky et al, 2006, Schreyögg and Grabka, 2010. So far, results have been mixed.…”

“…So far, results have been mixed. Augurzky et al (2006) report a negative and statistically significant difference-in-differences (DiD) coefficient in a logit model for "any visit". However, in their preferred specification they control for individual specific fixed effects, and the co-payment effect switches sign and becomes insignificant.…”

Do Optional Deductibles Reduce the Number of Doctor Visits? Empirical Evidence with German Data

“…In the German system, the former can choose between having a deductible or not whereas there are basically no deductibles for the latter. 1 The results are mixed. Pohlmeier and Ulrich (1995) find that the probability of visiting a general practitioner (GP) is higher for the publicly insured, that is, implicitly, for those with more insurance cover.…”