Abstract
This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further, we find that hospitals offering private insurees shorter waiting times when compared with SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.
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Notes
In reality, prices are not 100% fix. Prices are fixed within an upper and lower boundary of the length of stay of the patient, to account for less (more) cost-intensive in-(out-)liers. Moreover, special compensation rules apply if hospitals exceed or fall below the number of patient cases that was agreed upon with insurance companies.
Upcoding refers to switching patients from appropriate lower-paying to higher-paying DRGs to inflate reimbursement.
SHI holders can voluntarily purchase supplementary private insurance to cover additional hospital services. Currently 5.1 Million (7.1%) of SHI-insurees chose this option [27].
In 2006, the additional remuneration due to hotel benefits and treatment by the chief physician amounted to €2.5 billion, or 4% of total hospital revenues. For a one-bed room the revenue amounted to €82.61 per day, which is around 2.4% of average costs per patient in 2006 [10].
There is no literature to find how waiting lines are organized in German hospitals. Apparently, there is no standard or rule hospitals have to use by law. This means different staffers are assigned to organize waiting lines and different criteria could be used. The incentive to prefer PHI insures is nearly independent on the departments or staffs who are responsible for the waiting lines. The incentives for the management and especially the chief physician to privilege PHI insurees are very strong: the management is responsible for the success of the hospital and the chief physician normally gets some extra money for treating PHI insurees.
The evaluation of the PD is based on key operating figures, such as liquidity, the debt to equity ratio or current assets. See Augurzky et al. [2] for a more detailed description of the data and the model.
The number of hospitals is higher than the number of balance sheets due to the inclusion of hospital chains. These provide only one balance sheet for all hospitals in a chain. We do not consider purely psychiatric hospitals in our sample. See also Augurzky et al. [2].
Usually patients obtain appointments through the ambulatory health sector. The gate-keeper, i.e. the house doctor, provides his patients with an appointment for a hospital stay. To directly obtain an appointment, our interviewers told the hospital personnel that they had to abstain from a routine referral by their doctors due to a recent tenancy changeover to a new hometown.
The average lag between first and second call was 7 days. The lag was meant to be kept short to minimize the risk that a sudden change in capacity utilization of a hospital significantly affects waiting times. Where possible, to prevent the interviewer from being re-identified by the personnel of the hospital, second calls were done, by different interviewers. Furthermore, caller identification for all outgoing calls was blocked.
We thank Dr. Med. Lüder Herzog from the MDK Sachsen for his help in the selection of the appropriate clinical conditions.
The four-digit codes within the international classification of diagnoses in its 10th-German modification are “S82.6” for Weber B fracture, “I25.1” for stenosis and “C53.9” for cervical conisation.
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We would like to thank Jan Erik Askildsen, Christoph M. Schmidt and Marcus Tamm for many helpful comments and suggestions.
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Schwierz, C., Wübker, A., Wübker, A. et al. Discrimination in waiting times by insurance type and financial soundness of German acute care hospitals. Eur J Health Econ 12, 405–416 (2011). https://doi.org/10.1007/s10198-010-0254-2
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DOI: https://doi.org/10.1007/s10198-010-0254-2