Waiting times for outpatient treatment in Germany: New experimental evidence from primary data

Long waiting lines are a common feature and a major concern in many public health care delivery systems. The waiting lines are often characterized as inefficient, because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the preferential treatment given to private health insurance (PHI) holders while statutory health insurance (SHI) holders face continuously increasing waiting times. In order to tackle this problem in the outpatient sector, in 2015 Germany introduced a reform that was aimed at providing SHI holders with appointments within an acceptable time frame. We exploited longitudinal experimental data to examine waiting times for six elective outpatient treatments in Germany and assessed the reform's impact on this issue. We found a sizeable difference in waiting times favoring private patients. For SHI holders, waiting times remained stable over time (27.5 days in 2014; 30.7 days in 2016; ? 3.2 days, p-value = 0.889), while PHI holders experienced a significant improvement (13.5 days in 2014; 7.8 days in 2016; ? 5.7 days, p-value = 0.002). The results indicate that there is an unequal access to elective outpatient treatment depending on the patient's insurance status. Our conclusion is that, the reform did not repair the existing inequalities. The gap has rather widened.