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Insurance barriers and inequalities in health care access: evidence from dual practice

Author

Listed:
  • Eva Goetjes

    (University of Duisburg-Essen)

  • Katharina E. Blankart

    (University of Duisburg-Essen
    Leibniz Science Campus Ruhr
    Bern University of Applied Sciences)

Abstract

Background We investigate access disparities in pharmaceutical care among German patients with type 2 diabetes, focusing on differences between public and private health insurance schemes. The primary objectives include investigating whether patients with private health insurance experience enhanced access to antidiabetic care and analyzing whether the treatment received by public and private patients is influenced by the practice composition, particularly the proportion of private patients. Methods We estimate fixed effect regression models, to isolate the effect of insurance schemes on treatment choices. We utilize data from a prescriber panel comprising 681 physicians collectively serving 68,362 patients undergoing antidiabetic treatments. Results The analysis reveals a significant effect of the patient's insurance status on antidiabetic care access. Patients covered by private insurance show a 10-percentage-point higher likelihood of receiving less complex treatments compared to those with public insurance. Furthermore, the composition of physicians' practices plays a crucial role in determining the likelihood of patients receiving less complex treatments. Notably, the most pronounced disparities in access are observed in practices mirroring the regional average composition. Conclusions Our findings underscore strategic physician navigation across diverse health insurance schemes in ambulatory care settings, impacting patient access to innovative treatments.

Suggested Citation

  • Eva Goetjes & Katharina E. Blankart, 2024. "Insurance barriers and inequalities in health care access: evidence from dual practice," Health Economics Review, Springer, vol. 14(1), pages 1-16, December.
    • Handle: RePEc:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00500-y
    DOI: 10.1186/s13561-024-00500-y
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    References listed on IDEAS

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    1. Jeffrey Clemens & Joshua D. Gottlieb, 2014. "Do Physicians' Financial Incentives Affect Medical Treatment and Patient Health?," American Economic Review, American Economic Association, vol. 104(4), pages 1320-1349, April.
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    4. Walendzik, Anke & Greß, Stefan & Manouguian, Maral & Wasem, Jürgen, 2008. "Vergütungsunterschiede im ärztlichen Bereich zwischen PKV und GKV auf Basis des standardisierten Leistungsniveaus der GKV und Modelle der Vergütungsangleichung," IBES Diskussionsbeiträge 165, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
    5. Vincenzo Atella & Federico Belotti & Domenico Depalo, 2017. "Drug therapy adherence and health outcomes in the presence of physician and patient unobserved heterogeneity," Health Economics, John Wiley & Sons, Ltd., vol. 26(S2), pages 106-126, September.
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    More about this item

    Keywords

    Physician treatment style; Health insurance; Practice composition; Equity of care;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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