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Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

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  • Schreyögg, Jonas
  • Grabka, Markus M.

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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Bibliographic Info

Article provided by ZBW - German National Library of Economics in its journal EconStor Open Access Articles.

Volume (Year): (2010-06)
Issue (Month): ()
Pages: 331-341

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Handle: RePEc:zbw:espost:66149

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Keywords: Copayments; Ambulatory care; Difference-in-difference; Count data; Hurdle model;

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  1. Richard Blundell & Mónica Costa Dias, 2008. "Alternative Approaches to Evaluation in Empirical Microeconomics," CEF.UP Working Papers 0805, Universidade do Porto, Faculdade de Economia do Porto.
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Cited by:
  1. Wuppermann, Amelie Catherine, 2011. "Empirical Essays in Health and Education Economics," Munich Dissertations in Economics 13187, University of Munich, Department of Economics.
  2. Eibich, P.; & Ziebarth, N.;, 2013. "Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata," Health, Econometrics and Data Group (HEDG) Working Papers 13/12, HEDG, c/o Department of Economics, University of York.
  3. Alfredo R. Paloyo, 2009. "Co-pay and Feel Okay: Evidence of Illusory Health Gains from a Health Insurance Reform," SOEPpapers on Multidisciplinary Panel Data Research 225, DIW Berlin, The German Socio-Economic Panel (SOEP).
  4. Farbmacher, Helmut, 2009. "Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment," Discussion Papers in Economics 10951, University of Munich, Department of Economics.
  5. 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.
  6. Galina Besstremyannaya, 2012. "Heterogeneous effect of coinsurance rate on the demand for health care: a finite mixture approach," Working Papers w0163, Center for Economic and Financial Research (CEFIR).
  7. Laura Romeu Gordo & Andreas Motel-Klingebiel & Susanne Wurm, 2009. "SOEP as a Source for Research on Ageing – Issues, Measures and Possibilities for Improvement," Working Paper Series of the German Council for Social and Economic Data 83, German Council for Social and Economic Data (RatSWD).
  8. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Care Finance and Economics, Springer, vol. 14(1), pages 41-67, March.
  9. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie C. Wuppermann, 2013. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," CESifo Working Paper Series 4499, CESifo Group Munich.
  10. Helmut Farbmacher; & Joachim Winter, 2012. "Non-linear price schedules, demand for health care and response behavior," Health, Econometrics and Data Group (HEDG) Working Papers 12/15, HEDG, c/o Department of Economics, University of York.
  11. Janet Vroomen & Peter Zweifel, 2011. "Preferences for health insurance and health status: does it matter whether you are Dutch or German?," The European Journal of Health Economics, Springer, vol. 12(1), pages 87-95, February.

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