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Per‐Period Co‐Payments And The Demand For Health Care: Evidence From Survey And Claims Data

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  • Helmut Farbmacher
  • Joachim Winter

Abstract

When health insurance reforms involve non‐linear price schedules tied to payment periods (for example, fees levied by quarter or year), the empirical analysis of its effects has to take the within‐period time structure of incentives into account. The analysis is further complicated when demand data are obtained from a survey in which the reporting period does not coincide with the payment period. We illustrate these issues using as an example a health care reform in Germany that imposed a per‐quarter fee of €10 for doctor visits and additionally set an out‐of‐pocket maximum. This co‐payment structure results in an effective ‘spot’ price for a doctor visit that decreases over time within each payment period. Taking this variation into account, we find a substantial reform effect—especially so for young adults. Overall, the number of doctor visits decreased by around 9% in the young population. The probability of visiting a physician in any given quarter decreased by around 4 to 8 percentage points. Copyright © 2013 John Wiley & Sons, Ltd.

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  • Helmut Farbmacher & Joachim Winter, 2013. "Per‐Period Co‐Payments And The Demand For Health Care: Evidence From Survey And Claims Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1111-1123, September.
    • Handle: RePEc:wly:hlthec:v:22:y:2013:i:9:p:1111-1123
    DOI: 10.1002/hec.2955
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    Cited by:

    1. Stefanie Thönnes, 2019. "Ex-post moral hazard in the health insurance market: empirical evidence from German data," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(9), pages 1317-1333, December.
    2. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    3. Gregori Baetschmann & Rainer Winkelmann, 2014. "A dynamic hurdle model for zero-inflated count data: with an application to health care utilization," ECON - Working Papers 151, Department of Economics - University of Zurich.
    4. Johansson, Naimi & de New, Sonja C. & Kunz, Johannes S. & Petrie, Dennis & Svensson, Mikael, 2023. "Reductions in out-of-pocket prices and forward-looking moral hazard in health care demand," Journal of Health Economics, Elsevier, vol. 87(C).
    5. Kuhn, Michael & Ochsen, Carsten, 2019. "Population change and the regional distribution of physicians," The Journal of the Economics of Ageing, Elsevier, vol. 14(C).
    6. Rainer Winkelmann, 2014. "An Empirical Model of Health Care Demand under Non-linear Pricing," SOEPpapers on Multidisciplinary Panel Data Research 688, DIW Berlin, The German Socio-Economic Panel (SOEP).
    7. Kim Dalziel & Jinhu Li & Anthony Scott & Philip Clarke, 2018. "Accuracy of patient recall for self‐reported doctor visits: Is shorter recall better?," Health Economics, John Wiley & Sons, Ltd., vol. 27(11), pages 1684-1698, November.
    8. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie Wuppermann, 2017. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1234-1248, October.
    9. Johannes S. Kunz & Rainer Winkelmann, 2017. "An Econometric Model of Healthcare Demand With Nonlinear Pricing," Health Economics, John Wiley & Sons, Ltd., vol. 26(6), pages 691-702, June.
    10. Raúl Del Pozo-Rubio & Isabel Pardo-García & Francisco Escribano-Sotos, 2020. "Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment," IJERPH, MDPI, vol. 17(1), pages 1-19, January.
    11. Himmel, Konrad & Schneider, Udo, 2017. "Ambulatory care at the end of a billing period," hche Research Papers 14, University of Hamburg, Hamburg Center for Health Economics (hche).
    12. Andree Ehlert & Eva García‐Morán, 2022. "Workers' self‐selection into public sector employment: A tale of absenteeism," Kyklos, Wiley Blackwell, vol. 75(3), pages 394-409, August.

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