The Effect of Private Health Insurance on Medical Care Utilization and Self-Assessed Health in Germany
AbstractIn Germany, employees are generally obliged to participate in the public health insurance system, where coverage is universal, co-payments and deductibles are moderate, and premia are based on income. However, they may buy private insurance instead if their income exceeds the compulsory insurance threshold. Here, premia are based on age and health, individuals may choose to what extent they are covered, and deductibles and co-payments are common. In this paper, we estimate the effect of private insurance coverage on the number of doctor visits, the number of nights spent in a hospital and self-assessed health. Variation in income around the compulsory insurance threshold provides a natural experiment that we exploit to control for selection into private insurance. We document that income is measured with error and suggest an approach to take this into account. We find negative effects of private insurance coverage on the number of doctor visits, no effects on the number of nights spent in a hospital, and positive effects on health.
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Bibliographic InfoPaper provided by Institute for the Study of Labor (IZA) in its series IZA Discussion Papers with number 5004.
Length: 27 pages
Date of creation: Jun 2010
Date of revision:
Publication status: published in: Health Economics, 2010, 19(9), 1048-1062
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Other versions of this item:
- Patrick Hullegie & Tobias J. Klein, 2010. "The effect of private health insurance on medical care utilization and self‐assessed health in Germany," Health Economics, John Wiley & Sons, Ltd., vol. 19(9), pages 1048-1062, September.
- Hullegie P & Klein TJ, 2009. "The effect of private health insurance on medical care utilization and self-assessed health in Germany," Health, Econometrics and Data Group (HEDG) Working Papers 09/17, HEDG, c/o Department of Economics, University of York.
- I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
- I12 - Health, Education, and Welfare - - Health - - - Health Production
- C31 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Cross-Sectional Models; Spatial Models; Treatment Effect Models; Quantile Regressions; Social Interaction Models
This paper has been announced in the following NEP Reports:
- NEP-ALL-2010-07-03 (All new papers)
- NEP-EUR-2010-07-03 (Microeconomic European Issues)
- NEP-HEA-2010-07-03 (Health Economics)
- NEP-IAS-2010-07-03 (Insurance Economics)
Please report citation or reference errors to , or , if you are the registered author of the cited work, log in to your RePEc Author Service profile, click on "citations" and make appropriate adjustments.:
- David Card & Carlos Dobkin & Nicole Maestas, 2009.
"Does Medicare Save Lives?,"
The Quarterly Journal of Economics,
MIT Press, vol. 124(2), pages 597-636, May.
- Hahn, Jinyong & Todd, Petra & Van der Klaauw, Wilbert, 2001. "Identification and Estimation of Treatment Effects with a Regression-Discontinuity Design," Econometrica, Econometric Society, vol. 69(1), pages 201-09, January.
- Hendrik Jürges, 2009. "Health Insurance Status and Physician Behavior in Germany," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 129(2), pages 297-307.
- Chiappori, P.A. & Durand, F. & Geoffard, P.Y., 1998.
"Moral Hazard and the Demand for Physician Services: First Lessons from a French Natural Experiment,"
DELTA Working Papers
98-05, DELTA (Ecole normale supérieure).
- Chiappori, Pierre-Andre & Durand, Franck & Geoffard, Pierre-Yves, 1998. "Moral hazard and the demand for physician services: First lessons from a French natural experiment," European Economic Review, Elsevier, vol. 42(3-5), pages 499-511, May.
- Bound, John & Brown, Charles & Mathiowetz, Nancy, 2001. "Measurement error in survey data," Handbook of Econometrics, in: J.J. Heckman & E.E. Leamer (ed.), Handbook of Econometrics, edition 1, volume 5, chapter 59, pages 3705-3843 Elsevier.
- McCrary, Justin, 2008. "Manipulation of the running variable in the regression discontinuity design: A density test," Journal of Econometrics, Elsevier, vol. 142(2), pages 698-714, February.
- Battistin, Erich & Rettore, Enrico, 2008. "Ineligibles and eligible non-participants as a double comparison group in regression-discontinuity designs," Journal of Econometrics, Elsevier, vol. 142(2), pages 715-730, February.
- Kreider, Brent, 2007.
"Regression Coefficient Identification Decay in the Presence of Infrequent Classification Errors,"
Staff General Research Papers
12822, Iowa State University, Department of Economics.
- Brent Kreider, 2010. "Regression Coefficient Identification Decay in The Presence of Infrequent Classification Errors," The Review of Economics and Statistics, MIT Press, vol. 92(4), pages 1017-1023, November.
- Hanming Fang & Michael P. Keane & Dan Silverman, 2008.
"Sources of Advantageous Selection: Evidence from the Medigap Insurance Market,"
Journal of Political Economy,
University of Chicago Press, vol. 116(2), pages 303-350, 04.
- Hanming Fang & Michael P. Keane & Dan Silverman, 2006. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," NBER Working Papers 12289, National Bureau of Economic Research, Inc.
- Fang, Hanming & Keane, Michael & Silverman, Dan, 2006. "Sources of Advantageous Selection: Evidence from the Medigap Insurance Market," Working Papers 17, Yale University, Department of Economics.
- Joshua D. Angrist & Guido W. Imbens, 1995.
"Identification and Estimation of Local Average Treatment Effects,"
NBER Technical Working Papers
0118, National Bureau of Economic Research, Inc.
- Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-75, March.
- Wilbert van der Klaauw, 2008. "Regression-Discontinuity Analysis: A Survey of Recent Developments in Economics," LABOUR, CEIS, vol. 22(2), pages 219-245, 06.
- Winfried Pohlmeier & Volker Ulrich, 1995. "An Econometric Model of the Two-Part Decisionmaking Process in the Demand for Health Care," Journal of Human Resources, University of Wisconsin Press, vol. 30(2), pages 339-361.
- David Card & Carlos Dobkin & Nicole Maestas, 2008. "The Impact of Nearly Universal Insurance Coverage on Health Care Utilization: Evidence from Medicare," American Economic Review, American Economic Association, vol. 98(5), pages 2242-58, December.
- Imbens, Guido W. & Lemieux, Thomas, 2008.
"Regression discontinuity designs: A guide to practice,"
Journal of Econometrics,
Elsevier, vol. 142(2), pages 615-635, February.
- Guido Imbens & Thomas Lemieux, 2007. "Regression Discontinuity Designs: A Guide to Practice," NBER Working Papers 13039, National Bureau of Economic Research, Inc.
- Guido Imbens & Thomas Lemieux, 2007. "Regression Discontinuity Designs: A Guide to Practice," NBER Technical Working Papers 0337, National Bureau of Economic Research, Inc.
- Cutler, David M. & Zeckhauser, Richard J., 2000.
"The anatomy of health insurance,"
Handbook of Health Economics,
in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 11, pages 563-643
- Andreas Million & Regina T. Riphahn & Achim Wambach, 2003. "Incentive effects in the demand for health care: a bivariate panel count data estimation," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 18(4), pages 387-405.
- Willard G. Manning Jr. & Charles E. Phelps, 1979. "The Demand for Dental Care," Bell Journal of Economics, The RAND Corporation, vol. 10(2), pages 503-525, Autumn.
- Geil, Peter, et al, 1997. "Economic Incentives and Hospitalization in Germany," Journal of Applied Econometrics, John Wiley & Sons, Ltd., vol. 12(3), pages 295-311, May-June.
- Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-77, June.
- Christian Bünnings & Harald Tauchmann, 2013.
"Who Opts Out of the Statutory Health Insurance? A Discrete Time Hazard Model for Germany,"
Ruhr Economic Papers
0458, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
- Bünnings, Christian & Tauchmann, Harald, 2013. "Who opts out of the statutory health insurance? A discrete time hazard model for Germany," IWQW Discussion Paper Series 10/2013, Friedrich-Alexander-Universität Erlangen-Nürnberg, Institut für Wirtschaftspolitik und Quantitative Wirtschaftsforschung (IWQW).
- Bonsang, Eric & Klein, Tobias J., 2011.
"Retirement and Subjective Well-Being,"
IZA Discussion Papers
5536, Institute for the Study of Labor (IZA).
- Bonsang Eric & Klein Tobias J., 2011. "Retirement and Subjective Well-Being," Research Memorandum 028, Maastricht University, Maastricht Research School of Economics of Technology and Organization (METEOR).
- Bonsang Eric & Klein Tobias J., 2011. "Retirement and Subjective Well-Being," Research Memoranda 005, Maastricht : ROA, Research Centre for Education and the Labour Market.
- Bonsang Eric & Klein Tobias J., 2011. "Retirement and Subjective Well-Being," Research Memoranda 028, Maastricht : METEOR, Maastricht Research School of Economics of Technology and Organization.
- Bonsang Eric & Klein Tobias J., 2011. "Retirement and Subjective Well-Being," ROA Research Memorandum 005, Maastricht University, Research Centre for Education and the Labour Market (ROA).
- Denise Doiron & Denzil G Fiebig & Agne Suziedelyte, 2013. "Hips and hearts: the variation in incentive effects of insurance across hospital procedures," Discussion Papers 2013-14, School of Economics, The University of New South Wales.
- Wittwer, Jérôme & Guthmuller, Sophie, 2012. "Means-tested complementary health insurance and healthcare utilisation in France: Evidence from a low-income population," Economics Papers from University Paris Dauphine 123456789/9533, Paris Dauphine University.
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