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The effect of private health insurance on medical care utilization and self‐assessed health in Germany

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  • Patrick Hullegie
  • Tobias J. Klein

Abstract

In 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. Copyright (C) 2010 John Wiley & Sons, Ltd.

Suggested Citation

  • 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.
  • Handle: RePEc:wly:hlthec:v:19:y:2010:i:9:p:1048-1062
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    File URL: http://hdl.handle.net/10.1002/hec.1642
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    1. 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, April.
    2. 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.
    3. Imbens, Guido W & Angrist, Joshua D, 1994. "Identification and Estimation of Local Average Treatment Effects," Econometrica, Econometric Society, vol. 62(2), pages 467-475, March.
    4. 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.
    5. 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 Elsevier.
    6. Imbens, Guido W. & Lemieux, Thomas, 2008. "Regression discontinuity designs: A guide to practice," Journal of Econometrics, Elsevier, pages 615-635.
    7. 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.
    8. 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.
    9. 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.
    10. 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 201-209, January.
    11. 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 251-277, June.
    12. Brent Kreider, 2010. "Regression Coefficient Identification Decay in The Presence of Infrequent Classification Errors," The Review of Economics and Statistics, MIT Press, pages 1017-1023.
    13. David Card & Carlos Dobkin & Nicole Maestas, 2009. "Does Medicare Save Lives?," The Quarterly Journal of Economics, Oxford University Press, vol. 124(2), pages 597-636.
    14. 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.
    15. Wilbert van der Klaauw, 2008. "Regression-Discontinuity Analysis: A Survey of Recent Developments in Economics," LABOUR, CEIS, vol. 22(2), pages 219-245, June.
    16. 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.
    17. 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 2242-2258, December.
    18. 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.
    19. 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.
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    Cited by:

    1. Davezies, Laurent & Le Barbanchon, Thomas, 2017. "Regression discontinuity design with continuous measurement error in the running variable," Journal of Econometrics, Elsevier, vol. 200(2), pages 260-281.
    2. repec:eee:pubeco:v:154:y:2017:i:c:p:122-136 is not listed on IDEAS
    3. Christian Bünnings & Harald Tauchmann, 2015. "Who Opts out of the Statutory Health Insurance? A Discrete Time Hazard Model for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(10), pages 1331-1347, October.
    4. Polyakova, Maria, 2016. "Risk selection and heterogeneous preferences in health insurance markets with a public option," Journal of Health Economics, Elsevier, vol. 49(C), pages 153-168.
    5. YANAGI, Takahide, 2015. "Regression Discontinuity Designs with Nonclassical Measurement Error," Discussion Papers 2015-09, Graduate School of Economics, Hitotsubashi University.
    6. Robert Stelter, 2016. "Fertility and health insurance types in Germany," Discussion Papers (IRES - Institut de Recherches Economiques et Sociales) 2016021, Université catholique de Louvain, Institut de Recherches Economiques et Sociales (IRES).
    7. Bernal Lobato, N., 2014. "Essays in applied microeconomics," Other publications TiSEM 9b638b3d-2f83-452a-b2c8-c, Tilburg University, School of Economics and Management.
    8. repec:dau:papers:123456789/9533 is not listed on IDEAS
    9. repec:spr:stpapr:v:58:y:2017:i:4:d:10.1007_s00362-016-0745-z is not listed on IDEAS
    10. Takahide Yanagi, 2014. "The Effect of Measurement Error in the Sharp Regression Discontinuity Design," KIER Working Papers 910, Kyoto University, Institute of Economic Research.
    11. repec:zbw:rwirep:0458 is not listed on IDEAS
    12. Bonsang, Eric & Klein, Tobias J., 2012. "Retirement and subjective well-being," Journal of Economic Behavior & Organization, Elsevier, pages 311-329.
    13. Bernal, Noelia & Carpio, Miguel A. & Klein, Tobias J., 2017. "The effects of access to health insurance: Evidence from a regression discontinuity design in Peru," Journal of Public Economics, Elsevier, pages 122-136.
    14. René Petilliot, 2017. "The Effect of Private Health Insurance on Self-assessed Health Status and Health Satisfaction in Germany," SOEPpapers on Multidisciplinary Panel Data Research 917, DIW Berlin, The German Socio-Economic Panel (SOEP).
    15. Doiron, Denise & Fiebig, Denzil G. & Suziedelyte, Agne, 2014. "Hips and hearts: The variation in incentive effects of insurance across hospital procedures," Journal of Health Economics, Elsevier, vol. 37(C), pages 81-97.
    16. Jeon, Boyoung & Kwon, Soonman, 2013. "Effect of private health insurance on health care utilization in a universal public insurance system: A case of South Korea," Health Policy, Elsevier, vol. 113(1), pages 69-76.
    17. repec:eee:joecag:v:6:y:2015:i:c:p:24-43 is not listed on IDEAS
    18. Anikó Bíró, 2014. "Supplementary private health insurance and health care utilization of people aged 50+," Empirical Economics, Springer, vol. 46(2), pages 501-524, March.
    19. 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.
    20. Sebastian Panthöfer, 2016. "Risk Selection under Public Health Insurance with Opt‐Out," Health Economics, John Wiley & Sons, Ltd., vol. 25(9), pages 1163-1181, September.
    21. Firat Bilgel & Burhan Can Karahasan, 2017. "Self-Rated Health and Primary Care Utilization: Is Selection into Healthcare Endogenously Determined?," Working Papers 1079, Economic Research Forum, revised 04 Jun 2017.
    22. Petilliot, René, 2017. "The effect of private health insurance on self-assessed health status and health satisfaction in Germany," FZG Discussion Papers 65, University of Freiburg, Research Center for Generational Contracts (FZG).

    More about this item

    Keywords

    private health insurance ; medical care utilization ; selection into insurance ; natural experiment ; regression discontinuity design ; measurement error ;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I12 - Health, Education, and Welfare - - Health - - - Health Behavior
    • 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

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