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Journal of Public Health

, Volume 18, Issue 4, pp 351–365 | Cite as

Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

  • Stefan Gruber
  • Markus KieselEmail author
Original Article

Abstract

Aim

In view of increasing concern about a two-class system in the German health care sector, this study investigates the relevance of health insurance schemes and other socioeconomic characteristics to the level of specialist health care provision.

Subjects and Methods

Referring to Ronald M. Andersen’s model of health care utilization and more content-based approaches, we implement a negative binomial hurdle regression to estimate the number of specialist visits within the last 12 months. Our data source is the German sample of the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004.

Results

The results show that men’s number of specialist visits is markedly sensitive to predisposing and enabling factors, whereas women’s health care utilization depends less on such socioeconomic characteristics. With reference to previous findings concerning general practitioner consultation, the assumption of a bipolar health care system providing general practitioner care primarily to the statutory insured and specialist care to the privately insured is supported empirically as to men. Education, which is considered to be highly correlated with health lifestyles, has a positive effect on medical health care. Every additional year of education increases by about 10% the probability of men seeking specialist consultation. Furthermore, the results indicate an unfavorable situation for the self-employed concerning health care because of their specific employment situation and health insurance coverage.

Discussion

The research results suggest the existence of relevant differences in the amount of specialist consultation according to health insurance and other socioeconomic features. Further research could concentrate on the question of whether these inequalities in utilization levels indicate overprovision or underprovision of ambulant health care. Moreover, we recommend longitudinal research that is particularly suited to detangle age and cohort effects.

Keywords

Specialist consultation Health care utilization Health insurance Supply-induced demand Hurdle regression 

Notes

Acknowledgments

We wish to thank Prof. Dr. Henriette Engelhardt-Wölfler for her support and suggestions. Also, our appreciation goes to Dr. Andreas Mielck for his useful comments following the Health Inequalities III conference in Bielefeld.

The SHARE data collection has been primarily funded by the European Commission through the 5th framework program (project QLK6-CT-2001-00360 in the thematic program Quality of Life). Additional funding came from the US National Institute on Aging (U01 AG09740-13S2, P01 AG005842, P01 AG08291, P30 AG12815, Y1-AG-4553-01 and OGHA 04-064). Further support by the European Commission through the 6th framework program (projects SHARE-13, RII-CT-2006-062193 and COMPARE, CIT5-CT-2005-028857) is gratefully acknowledged.

Conflict of interest

The authors declare they have no relevant associations that might pose a conflict of interest.

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  1. 1.Institut für Arbeitsmarkt-und BerufsforschungNurembergGermany
  2. 2.Bremen International Graduate School of Social Sciences, Wiener Straße/CelsiusstraßeBremenGermany

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