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Willingness to pay for health insurance among the elderly population in Germany

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Abstract

Introduction

All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.

Methods

Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57–84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals’ WTP was elicited based on a contingent valuation method with a payment card.

Results

Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20 % of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.

Discussion

The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.

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Acknowledgments

This study was funded by the German Federal Ministry of Education and Research (Grant numbers 01ET0717, 01ET0718, 01ET0719, 01ET1004A, 01ET1004B, 01ET1004C).

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Authors and Affiliations

  1. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jens-Oliver Bock, Dirk Heider, Herbert Matschinger & Hans-Helmut König

  2. Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straβe 55, 04103, Leipzig, Germany

    Herbert Matschinger

  3. Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany

    Hermann Brenner & Kai-Uwe Saum

  4. Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany

    Hermann Brenner

  5. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Walter E. Haefeli

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  1. Jens-Oliver Bock
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  2. Dirk Heider
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Correspondence to Jens-Oliver Bock.

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Bock, JO., Heider, D., Matschinger, H. et al. Willingness to pay for health insurance among the elderly population in Germany. Eur J Health Econ 17, 149–158 (2016). https://doi.org/10.1007/s10198-014-0663-8

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  • DOI: https://doi.org/10.1007/s10198-014-0663-8

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