IDEAS home Printed from https://ideas.repec.org/a/spr/hecrev/v14y2024i1d10.1186_s13561-024-00500-y.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1186/s13561-024-00500-y
    File Function: Abstract
    Download Restriction: no
    File URL: https://libkey.io/10.1186/s13561-024-00500-y?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Mummolo, Jonathan & Peterson, Erik, 2018. "Improving the Interpretation of Fixed Effects Regression Results," Political Science Research and Methods, Cambridge University Press, vol. 6(4), pages 829-835, October.
    2. 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.
    3. 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.
    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. repec:wly:hlthec:v:26:y:2017:i::p:106-126 is not listed on IDEAS
    Full references (including those not matched with items on IDEAS)

    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. Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2021. "Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment," Journal of Economic Behavior & Organization, Elsevier, vol. 188(C), pages 1325-1350.
    2. Michael Geruso & Timothy Layton, 2020. "Upcoding: Evidence from Medicare on Squishy Risk Adjustment," Journal of Political Economy, University of Chicago Press, vol. 128(3), pages 984-1026.
    3. Federico Belotti & Joanna Kopinska & Alessandro Palma & Andrea Piano Mortari, 2022. "Health status and the Great Recession. Evidence from electronic health records," Health Economics, John Wiley & Sons, Ltd., vol. 31(8), pages 1770-1799, August.
    4. Gabriel A. Facchini Palma, 2020. "Low Staffing in the Maternity Ward: Keep Calm and Call the Surgeon," Working Papers wpdea2009, Department of Applied Economics at Universitat Autonoma of Barcelona.
    5. Jeffrey Clemens & Joshua D. Gottlieb & Jeffrey Hicks, 2021. "How Would Medicare for All Affect Health System Capacity? Evidence from Medicare for Some," Tax Policy and the Economy, University of Chicago Press, vol. 35(1), pages 225-262.
    6. Jeon, Heung-Jae & Jung, Sumi, 2024. "Generalist vs. Specialist CEOs: R&D Investment Sensitivity to Stock Price," Finance Research Letters, Elsevier, vol. 62(PA).
    7. Dunn, Abe & Shapiro, Adam Hale, 2015. "Physician payments under health care reform," Journal of Health Economics, Elsevier, vol. 39(C), pages 89-105.
    8. Mengna Luan & Wenjing Shi & Zhigang Tao & Hongjie Yuan, 2023. "When patients have better insurance coverage in China: Provider incentives, costs, and quality of care," Economics of Transition and Institutional Change, John Wiley & Sons, vol. 31(4), pages 1073-1106, October.
    9. Brekke, Kurt R. & Holmås, Tor Helge & Monstad, Karin & Straume, Odd Rune, 2017. "Do treatment decisions depend on physicians' financial incentives?," Journal of Public Economics, Elsevier, vol. 155(C), pages 74-92.
    10. Azémar, Céline & Desbordes, Rodolphe & Wooton, Ian, 2020. "Is international tax competition only about taxes? A market-based perspective," Journal of Comparative Economics, Elsevier, vol. 48(4), pages 891-912.
    11. Amaral-Garcia, S.;, 2022. "Medical Device Companies and Doctors: Do their interactions affect medical treatments?," Health, Econometrics and Data Group (HEDG) Working Papers 22/10, HEDG, c/o Department of Economics, University of York.
    12. Pablo A. Celhay & Paul J. Gertler & Paula Giovagnoli & Christel Vermeersch, 2019. "Long-Run Effects of Temporary Incentives on Medical Care Productivity," American Economic Journal: Applied Economics, American Economic Association, vol. 11(3), pages 92-127, July.
    13. Alexander Ahammer & Ivan Zilic, 2017. "Do Financial Incentives Alter Physician Prescription Behavior? Evidence from Random Patient-GP Allocations," Working Papers 1701, The Institute of Economics, Zagreb.
    14. Jeannette Brosig‐Koch & Burkhard Hehenkamp & Johanna Kokot, 2017. "The effects of competition on medical service provision," Health Economics, John Wiley & Sons, Ltd., vol. 26(S3), pages 6-20, December.
    15. Bahnsen, Lewe & Wild, Frank, 2025. "Mehrumsatz und Leistungsausgaben von Privatversicherten: Jahresbericht 2025," WIP-Analysen März 2025, WIP – Wissenschaftliches Institut der PKV.
    16. Gneezy, Uri & Saccardo, Silvia & Serra-Garcia, Marta & van Veldhuizen, Roel, 2020. "Bribing the Self," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 120, pages 311-324.
    17. Alaka Holla & Jishnu Das & Aakash Mohpal & Karthik Muralidharan, 2015. "Quality and Accountability in Healthcare Delivery: Audit Evidence from Primary Care Providers in India," Working Papers id:7219, eSocialSciences.
    18. Thomas Bourveau & Alexandre Garel & Peter Joos & Arthur Petit-Romec, 2024. "When attention is away, analysts misplay: distraction and analyst forecast performance," Review of Accounting Studies, Springer, vol. 29(1), pages 916-958, March.
    19. Barili, Emilia & Bertoli, Paola & Grembi, Veronica, 2021. "Neighborhoods, networks, and delivery methods," Journal of Health Economics, Elsevier, vol. 80(C).
    20. Leila Agha & Keith Marzilli Ericson & Xiaoxi Zhao, 2020. "The Impact of Organizational Boundaries on Healthcare Coordination and Utilization," NBER Working Papers 28179, National Bureau of Economic Research, Inc.

    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

    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:spr:hecrev:v:14:y:2024:i:1:d:10.1186_s13561-024-00500-y. 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: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com/economics/journal/13561 .

    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.