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

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  • Jonas Schreyögg
  • Markus M. Grabka

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

Paper provided by DIW Berlin, The German Socio-Economic Panel (SOEP) in its series SOEPpapers on Multidisciplinary Panel Data Research with number 96.

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Length: 26 p.
Date of creation: 2008
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Handle: RePEc:diw:diwsop:diw_sp96

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Keywords: Copayments; ambulatory care; difference-in-difference; count data; zeroinflated-model; SOEP;

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References

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  2. Jiale Zhang, 2007. "A DID analysis of the impact of health insurance reform in the city of Hangzhou," Health Economics, John Wiley & Sons, Ltd., John Wiley & Sons, Ltd., vol. 16(12), pages 1389-1402.
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  7. Boris Augurzky & Thomas Bauer & Sandra Schaffner, 2006. "Copayments in the German Health System – Do They Work?," RWI Discussion Papers, Rheinisch-Westfälisches Institut für Wirtschaftsforschung 0043, Rheinisch-Westfälisches Institut für Wirtschaftsforschung.
  8. William H. Greene, 1994. "Accounting for Excess Zeros and Sample Selection in Poisson and Negative Binomial Regression Models," Working Papers, New York University, Leonard N. Stern School of Business, Department of Economics 94-10, New York University, Leonard N. Stern School of Business, Department of Economics.
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Cited by:
  1. 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, University of Munich, Department of Economics 10951, University of Munich, Department of Economics.
  2. Laura Romeu Gordo & Andreas Motel-Klingebiel & Susanne Wurm, 2009. "SOEP as a Source for Research on Ageing: Issues, Measures and Possibilities for Improvement," SOEPpapers on Multidisciplinary Panel Data Research 173, DIW Berlin, The German Socio-Economic Panel (SOEP).
  3. Peter Eibich & Nicolas R. Ziebarth, 2013. "Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata," SOEPpapers on Multidisciplinary Panel Data Research 551, DIW Berlin, The German Socio-Economic Panel (SOEP).
  4. 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.
  5. Helmut Farbmacher; & Joachim Winter, 2012. "Non-linear price schedules, demand for health care and response behavior," Health, Econometrics and Data Group (HEDG) Working Papers, HEDG, c/o Department of Economics, University of York 12/15, HEDG, c/o Department of Economics, University of York.
  6. 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, Springer, vol. 12(1), pages 87-95, February.
  7. 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).
  8. 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).
  9. 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, Elsevier, vol. 32(6), pages 1240-1249.
  10. 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, Springer, vol. 14(1), pages 41-67, March.
  11. Wuppermann, Amelie Catherine, 2011. "Empirical Essays in Health and Education Economics," Munich Dissertations in Economics, University of Munich, Department of Economics 13187, University of Munich, Department of Economics.

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