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Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?

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  • Johannes Schwarze
  • Hanfried H. Andersen
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    Abstract

    It is currently intensively discussed whether the system of risk structure adjustment (RSA) among German statutory sickness funds should be supplemented by morbidity indicators. It has been showed that employees who change their sickness funds are better risks and thus shift the morbidity structure in advantage to the funds they change to. Using data drawn from the German Socio-Economic Panel Study (GSOEP) we analyze why German employees change their sickness fund. We find that the contribution rate is the most important determinant. A one percent change in the contribution rate will increase the probability of change by four percent. The probability is also positively effected by earnings up to the assessable income limit but decreasing with age. Regarding to the RSA debate the results are not clear: While the extent of utilization of the stationary medical care system has a negative impact on the probability of changing we find a positive effect of ambulant utilization. Thus, it is not clear whether changers are the better risks. Die aktuelle Diskussion über den Risikostrukturausgleich (RSA) zwischen den Gesetzlichen Krankenkassen konzentriert sich auf die Frage, ob zusätzlich Morbiditätsmerkmale berücksichtigt werden sollen. Vorliegende Studien deuten darauf hin, dass Kassenwechsler im Durchschnitt bessere Risiken sind. In diesem Beitrag werden die Determinanten des Kassenwechsels mit Daten des Sozio-oekonomischen Panels (SOEP) analysiert. Dabei zeigt sich, dass der Beitragssatz die entscheidende Determinante ist. Eine Steigerung des Beitragssatzes um einen Prozentpunkt erhöht die Wahrscheinlichkeit eines Wechsels im Durchschnitt um 4 Prozentpunkte. Einen positiven Einfluss auf die Wechselwahrscheinlichkeit hat auch das Erwerbseinkommen, allerdings nur bis zur Höhe der Beitragsbemessungsgrenze. Ältere Menschen wechseln hingegen weniger häufig die Krankenkasse. Im Hinblick auf die Inanspruchnahme von Leistungen des Gesundheitssystems sind die Ergebnisse nicht eindeutig: Während mit steigender stationärer Inanspruchnahme die Wahrscheinlichkeit eines Kassenwechsels abnimmt, zeigt sich für die ambulante Inanspruchnahme ein positiver Einfluss.

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    Bibliographic Info

    Paper provided by DIW Berlin, German Institute for Economic Research in its series Discussion Papers of DIW Berlin with number 267.

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    Length: 22 p.
    Date of creation: 2001
    Date of revision:
    Handle: RePEc:diw:diwwpp:dp267

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    References

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    1. Friedrich Breyer & Mathias Kifmann, 2001. "Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV," Discussion Papers of DIW Berlin 236, DIW Berlin, German Institute for Economic Research.
    2. Friedrich Breyer & Mathias Kifmann & Erika Schulz, 2001. "Risikostrukturausgleich am Scheideweg: Senkung der Wirtschaftlichkeitsanreize für die Krankenkassen sollte vermieden werden," DIW Wochenbericht, DIW Berlin, German Institute for Economic Research, vol. 68(14), pages 213-219.
    3. Johannes Schwarze & Hanfried H. Andersen & Silke Anger, 2000. "Self-Rated Health and Changes in Self-Rated Health as Predictors of Mortality: First Evidence from German Panel Data," Discussion Papers of DIW Berlin 203, DIW Berlin, German Institute for Economic Research.
    4. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-38, May.
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    Cited by:
    1. Andersen, Hanfried H. & Grabka, Markus M. & Schwarze, Johannes, 2007. "Beitragssatz, Kassenwettbewerb und Gesundheitsreform: Eine empirische Analyse," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 429-450.
    2. Stefan Greß, 2002. "Freie Kassenwahl und Preiswettbewerb in der GKV: Effekte und Perspektiven," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 71(4), pages 490 -497.
    3. Höppner, Karin & Greß, Stefan & Rothgang, Heinz & Wasem, Jürgen & Braun, Bernard & Buitkamp, Martin, 2005. "Grenzen und Dysfunktionalitäten des Kassenwettbewerbs in der GKV: Theorie und Empirie der Risikolektion in Deutschland," Working papers of the ZeS 04/2005, University of Bremen, Centre for Social Policy Research (ZeS).
    4. Dieter Cassel, 2004. "Vermeidung von Risikoselektion als wettbewerbspolitische Gestaltungsaufgabe in der GKV: Korreferat zu den Beiträgen von Robert Nuscheler: "Krankenkassenwettbewerb in der GKV: Evidenz für Risiko," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 73(4), pages 555-563.
    5. Bettina Becker & Silke Uebelmesser, 2010. "Health Insurance Competition in Germany - the Role of Advertising," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 130(2), pages 169-194.
    6. Karolin Becker & Peter Zweifel, 2005. "Cost Sharing in Health Insurance: An Instrument for Risk Selection?," SOI - Working Papers 0513, Socioeconomic Institute - University of Zurich.
    7. Markus Wörz & Reinhard Busse, 2005. "Analysing the impact of health-care system change in the EU member states - Germany," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages S133-S149.
    8. Göpffarth, Dirk, 2004. "Die Reform des Risikostrukturausgleichs: Eine Zwischenbilanz," Discussion Papers 2004/18, Technische Universität Berlin, School of Economics and Management.
    9. Marcus Tamm & Harald Tauchmann & Stefan Greß & Jürgen Wasem, 2005. "Price Elasticities and Social Health Insurance Choice in Germany: A Dynamic Panel Data Approach," RWI Discussion Papers 0028, Rheinisch-Westfälisches Institut für Wirtschaftsforschung.
    10. Marcus Tamm & Harald Tauchmann & Jürgen Wasem & Stefan Gre�, 2007. "Elasticities of market shares and social health insurance choice in germany: a dynamic panel data approach," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 243-256.
    11. Knaus, Thomas & Nuscheler, Robert, 2002. "Incomplete risk adjustment and adverse selection in the German public health insurance system," Discussion Papers, Research Unit: Market Processes and Governance FS IV 02-27, Social Science Research Center Berlin (WZB).

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