IDEAS home Printed from https://ideas.repec.org/p/diw/diwwpp/dp267.html
   My bibliography  Save this paper

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

Author

Listed:
  • Johannes Schwarze
  • Hanfried H. Andersen

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.

Suggested Citation

  • Johannes Schwarze & Hanfried H. Andersen, 2001. "Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?," Discussion Papers of DIW Berlin 267, DIW Berlin, German Institute for Economic Research.
    • Handle: RePEc:diw:diwwpp:dp267
    as

    Download full text from publisher

    File URL: https://www.diw.de/documents/publikationen/73/diw_01.c.38505.de/dp267.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    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. 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.
    3. 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.
    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 334-338, May.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Pilny, Adam & Wübker, Ansgar & Ziebarth, Nicolas R., 2017. "Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany," Journal of Health Economics, Elsevier, vol. 56(C), pages 330-351.
    2. Schmitz, Hendrik & Ziebarth, Nicolas R., 2011. "In Absolute or Relative Terms? How Framing Prices Affects the Consumer Price Sensitivity of Health Plan Choice," IZA Discussion Papers 6241, Institute of Labor Economics (IZA).
    3. Andersen, Hanfried H. & Grabka, Markus M. & Schwarze, Johannes, 2007. "Beitragssatz, Kassenwettbewerb und Gesundheitsreform: Eine empirische Analyse," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 227(5/6), pages 429-450.
    4. repec:zbw:rwidps:0028 is not listed on IDEAS
    5. 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).
    6. 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.
    7. Hendrik Schmitz & Nicolas R. Ziebarth, 2011. "In Absolute or Relative Terms? How Framing Prices Affects the Consumer Price Sensitivity of," Ruhr Economic Papers 0304, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    8. Knaus, Thomas & Nuscheler, Robert, 2002. "Incomplete risk adjustment and adverse selection in the German public health insurance system [Unvollständiger Risikostrukturausgleich und Adverse Selektion in der Gesetzlichen Krankenversicherung ," Discussion Papers, Research Unit: Market Processes and Governance FS IV 02-27, WZB Berlin Social Science Center.
    9. Marcus Tamm & Harald Tauchmann & Jürgen Wasem & Stefan Greß, 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, March.
    10. Greß, Stefan & Tamm, Marcus & Tauchmann, Harald & Wasem, Jürgen, 2005. "Price Elasticities and Social Health Insurance Choice in Germany: A Dynamic Panel Data Approach," RWI Discussion Papers 28, RWI - Leibniz-Institut für Wirtschaftsforschung.
    11. Göpffarth, Dirk, 2004. "Die Reform des Risikostrukturausgleichs: Eine Zwischenbilanz," Discussion Papers 2004/18, Technische Universität Berlin, School of Economics and Management.
    12. repec:zbw:rwirep:0304 is not listed on IDEAS
    13. Jonas Pendzialek & Dusan Simic & Stephanie Stock, 2016. "Differences in price elasticities of demand for health insurance: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 17(1), pages 5-21, January.
    14. Karolin Becker & Peter Zweifel, 2005. "Cost Sharing in Health Insurance: An Instrument for Risk Selection?," SOI - Working Papers 0513, Socioeconomic Institute - University of Zurich.
    15. Pendzialek, Jonas B. & Danner, Marion & Simic, Dusan & Stock, Stephanie, 2015. "Price elasticities in the German Statutory Health Insurance market before and after the health care reform of 2009," Health Policy, Elsevier, vol. 119(5), pages 654-663.
    16. Dieterich, Felix, 2005. "Risikoselektion und Risikoausgleich am Beispiel der gesetzlichen Krankenkassen in Deutschland," Discussion Papers in Economics 718, University of Munich, Department of Economics.
    17. 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 133-149, September.
    18. Andersen Hanfried H. & Grabka Markus M. & Schwarze Johannes, 2007. "Beitragssatz, Kassenwettbewerb und Gesundheitsreform / Premium Rates, Competition Among Health Insurance Funds and the Health Care Reform 2007: Eine empirische Analyse / An Empirical Analysis," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 227(5-6), pages 429-450, October.
    19. 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.
    20. 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.
    21. 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 Risikose," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 73(4), pages 555-563.
    22. Robert Nuscheler, 2004. "Krankenkassenwettbewerb in der GKV: Evidenz für Risikoselektion?," Vierteljahrshefte zur Wirtschaftsforschung / Quarterly Journal of Economic Research, DIW Berlin, German Institute for Economic Research, vol. 73(4), pages 528-538.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Dieterich, Felix, 2005. "Risikoselektion und Risikoausgleich am Beispiel der gesetzlichen Krankenkassen in Deutschland," Discussion Papers in Economics 718, University of Munich, Department of Economics.
    2. Maria De Paola & Vincenzo Scoppa, 2010. "Peer group effects on the academic performance of Italian students," Applied Economics, Taylor & Francis Journals, vol. 42(17), pages 2203-2215.
    3. Salimata Sissoko, 2011. "Working Paper 03-11 - Niveau de décentralisation de la négociation et structure des salaires," Working Papers 1103, Federal Planning Bureau, Belgium.
    4. Stephen Drinkwater, 2003. "Go West? Assessing the willingness to move from Central and Eastern European Countries," School of Economics Discussion Papers 0503, School of Economics, University of Surrey.
    5. Manthos D. Delis & Sotirios Kokas & Steven Ongena, 2016. "Foreign Ownership and Market Power in Banking: Evidence from a World Sample," Journal of Money, Credit and Banking, Blackwell Publishing, vol. 48(2-3), pages 449-483, March.
    6. Giuseppe Croce & Emanuela Ghignoni, 2011. "Overeducation and spatial flexibility in Italian local labour markets," Working Papers in Public Economics 145, University of Rome La Sapienza, Department of Economics and Law.
    7. Thomas Crossley & Mario Jametti, 2013. "Pension Benefit Insurance and Pension Plan Portfolio Choice," The Review of Economics and Statistics, MIT Press, vol. 95(1), pages 337-341, March.
    8. David G. Blanchflower & Andrew Oswald, 1995. "International Wage Curves," NBER Chapters, in: Differences and Changes in Wage Structures, pages 145-174, National Bureau of Economic Research, Inc.
    9. Philippe Martin & Thierry Mayer & Florian Mayneris, 2008. "Spatial Concentration and Firm-Level Productivity in France," Sciences Po publications 6858, Sciences Po.
    10. Sylvain Chassang & Erik Snowberg & Ben Seymour & Cayley Bowles, 2015. "Accounting for Behavior in Treatment Effects: New Applications for Blind Trials," PLOS ONE, Public Library of Science, vol. 10(6), pages 1-13, June.
    11. Valentine Fays & Benoît Mahy & François Rycx, 2023. "Wage differences according to workers' origin: The role of working more upstream in GVCs," LABOUR, CEIS, vol. 37(2), pages 319-342, June.
    12. Nucci, Francesco & Pozzolo, Alberto Franco, 2010. "The exchange rate, employment and hours: What firm-level data say," Journal of International Economics, Elsevier, vol. 82(2), pages 112-123, November.
    13. David Campbell, 2001. "Rates of Return to Schooling and the Quality of Education in England and Wales," Studies in Economics 0115, School of Economics, University of Kent.
    14. Ose, Solveig Osborg, 2005. "Working conditions, compensation and absenteeism," Journal of Health Economics, Elsevier, vol. 24(1), pages 161-188, January.
    15. Gijs Roelofs & Daniel Vuuren, 2017. "The Decentralization of Social Assistance and the Rise of Disability Insurance Enrolment," De Economist, Springer, vol. 165(1), pages 1-21, March.
    16. Knack, Steve & Xu, Lixin Colin, 2017. "Unbundling institutions for external finance: Worldwide firm-level evidence," Journal of Corporate Finance, Elsevier, vol. 44(C), pages 215-232.
    17. Nattavudh Powdthavee, 2005. "Unhappiness and Crime: Evidence from South Africa," Economica, London School of Economics and Political Science, vol. 72(287), pages 531-547, August.
    18. Jacob Veenstra & Bernard Ommeren, 2017. "Bailout Clauses and the Price of Credit: The Dutch Experience for Housing Corporations," De Economist, Springer, vol. 165(3), pages 295-320, September.
    19. Thomas, Duncan & Strauss, John, 1997. "Health and wages: Evidence on men and women in urban Brazil," Journal of Econometrics, Elsevier, vol. 77(1), pages 159-185, March.
    20. Philip Du Caju & François Rycx & Ilan Tojerow, 2011. "Inter‐Industry Wage Differentials: How Much Does Rent Sharing Matter?," Manchester School, University of Manchester, vol. 79(4), pages 691-717, July.

    More about this item

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • C25 - Mathematical and Quantitative Methods - - Single Equation Models; Single Variables - - - Discrete Regression and Qualitative Choice Models; Discrete Regressors; Proportions; Probabilities

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:diw:diwwpp:dp267. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Bibliothek (email available below). General contact details of provider: https://edirc.repec.org/data/diwbede.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.