Abstract
In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health-care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.
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Notes
In the absence of WHO data for Germany, we have used data on the number of physician contacts, provided by the German Socio-Economic Panel (SOEP) for the year 2006. According to a study based on claims data from one of the largest German sickness funds, the average person in Germany makes as many as 16.3 physician visits annually [2].
One would assume that with the introduction of copayments in the SHI, individuals who can opt for the PHI showed a higher probability to switch to the PHI. However, the PHI attracted even fewer new members in 2004 than in previous years [15].
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Schreyögg, J., Grabka, M.M. Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach. Eur J Health Econ 11, 331–341 (2010). https://doi.org/10.1007/s10198-009-0179-9
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DOI: https://doi.org/10.1007/s10198-009-0179-9