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Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

  • Jonas Schreyögg
  • Markus M. Grabka

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.

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Paper provided by DIW Berlin, The German Socio-Economic Panel (SOEP) in its series SOEPpapers on Multidisciplinary Panel Data Research with number 96.

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Length: 26 p.
Date of creation: 2008
Date of revision:
Handle: RePEc:diw:diwsop:diw_sp96
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  1. Boris Augurzky & Thomas Bauer & Sandra Schaffner, 2006. "Copayments in the German Health System – Do They Work?," RWI Discussion Papers 0043, Rheinisch-Westfälisches Institut für Wirtschaftsforschung.
  2. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
  3. Vuong, Quang H, 1989. "Likelihood Ratio Tests for Model Selection and Non-nested Hypotheses," Econometrica, Econometric Society, vol. 57(2), pages 307-33, March.
  4. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics, Palgrave Macmillan.
  5. Jiale Zhang, 2007. "A DID analysis of the impact of health insurance reform in the city of Hangzhou," Health Economics, John Wiley & Sons, Ltd., vol. 16(12), pages 1389-1402.
  6. 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.
  7. Augurzky, Boris & Bauer, Thomas K. & Schaffner, Sandra, 2006. "Copayments in the German Health System - Do They Work?," RWI Discussion Papers 43, Rheinisch-Westfälisches Institut für Wirtschaftsforschung (RWI).
  8. William H. Greene, 1994. "Accounting for Excess Zeros and Sample Selection in Poisson and Negative Binomial Regression Models," Working Papers 94-10, New York University, Leonard N. Stern School of Business, Department of Economics.
  9. Elofsson, Stig & Undén, Anna-Lena & Krakau, Ingvar, 1998. "Patient charges -- a hindrance to financially and psychosocially disadvantage groups seeking care," Social Science & Medicine, Elsevier, vol. 46(10), pages 1375-1380, March.
  10. Gert G. Wagner & Joachim R. Frick & Jürgen Schupp, 2007. "The German Socio-Economic Panel Study (SOEP): Scope, Evolution and Enhancements," SOEPpapers on Multidisciplinary Panel Data Research 1, DIW Berlin, The German Socio-Economic Panel (SOEP).
  11. J. Scott Long & Jeremy Freese, 2006. "Regression Models for Categorical Dependent Variables using Stata, 2nd Edition," Stata Press books, StataCorp LP, edition 2, number long2, November.
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