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Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany

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Abstract

Due to a problematic situation with public finances, Germany introduced a copayment scheme for ambulatory care visits in 2004. In 2012, Germany achieved a balanced budget, and copayment was abolished on the 1st of January 2013. This policy change offers a rare opportunity to explore the impact of the abolition of copayment, compared to the much more frequently studied introduction of copayment. We therefore investigate the development of ambulatory care and inpatient care utilization following this policy change among people over 50 in Germany, as well as the heterogeneous impacts among vulnerable people, such as the low-income population, the chronically ill and the elderly over the age of 65. We use data from the Survey of Health, Ageing and Retirement in Europe and adopt a difference-in-differences approach with matching. We found that the abolition of copayment only caused an increase in ambulatory care use in the shorter term, while leading to a significant reduction in the longer term. In addition, we find a negative effect on inpatient care use, i.e., the hospitalization offset effect. Finally, we demonstrate that vulnerable people were more sensitive to the abolition of copayment.

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Acknowledgements

This paper uses data from SHARE Waves 2, 4, 6 and 7 (DOIs: https://doi.org/10.6103/SHARE.w2.700, https://doi.org/10.6103/SHARE.w4.700, https://doi.org/10.6103/SHARE.w6.700, https://doi.org/10.6103/SHARE.w7.700), see Börsch-Supan et al. (2013) for methodological details. The SHARE data collection has been funded by the European Commission through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982) and Horizon 2020 (SHARE-DEV3: GA N°676536, SERISS: GA N°654221) and by DG Employment, Social Affairs & Inclusion. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C) and from various national funding sources is gratefully acknowledged (see www.share-project.org). We would like to extend our sincere thanks to Dr. Yuanyuan Gu, Prof. Matt Sutton, Prof. Andrew Jones, Dr. Anne Nolan, Dr. Alex Turner, Dr. Stephen O’Neill and Prof. Florence Jusot, who have provided valuable suggestions and commons in the European Health Economics Association workshop. We also acknowledge valuable suggestions and supports from Prof. Dr. Berthold U. Wigger, Prof. Dr. Nora Szech, Prof. Dr. Marcus Wouters and Prof. Dr. Andreas Geyer-Schulz. We are thankful for advice from the attendees of the Austrian Health Economics Association conference.

Funding

This work is supported by the China Scholarship Council (CSC) [grant numbers: 201606010333]. The funding source had no involvement in the whole process of the research.

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  1. School of Public Health (Shenzhen), Sun Yat-sen University, Gongchang Road 66, Shenzhen, 518107, China

    Mingming Xu

  2. Department of Economics and Management, Karlsruhe Institute of Technology, Kronenstraβe 34, 76133, Karlsruhe, Germany

    Mingming Xu

  3. Austrian Institute of Economic Research (WIFO), Arsenal, Objekt 20, 1030, Vienna, Austria

    Benjamin Bittschi

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MX: Conceptualization; Data curation; Formal analysis; Methodology; Roles/Writing—original draft; Writing—review & editing. BB: Data curation; Methodology; Writing—review & editing.

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Xu, M., Bittschi, B. Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany. Eur J Health Econ 23, 1319–1328 (2022). https://doi.org/10.1007/s10198-022-01430-4

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