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Kassenwechsel in der gesetzlichen Krankenversicherung: welche Rolle spielt der Beitragssatz?

  • Johannes Schwarze
  • Hanfried H. Andersen
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    It is currently intensively discussed whether the system of risk structure adjustment (RSA) among German statutory sickness funds should be supplemented by morbidity indicators. It has been showed that employees who change their sickness funds are better risks and thus shift the morbidity structure in advantage to the funds they change to. Using data drawn from the German Socio-Economic Panel Study (GSOEP) we analyze why German employees change their sickness fund. We find that the contribution rate is the most important determinant. A one percent change in the contribution rate will increase the probability of change by four percent. The probability is also positively effected by earnings up to the assessable income limit but decreasing with age. Regarding to the RSA debate the results are not clear: While the extent of utilization of the stationary medical care system has a negative impact on the probability of changing we find a positive effect of ambulant utilization. Thus, it is not clear whether changers are the better risks. Die aktuelle Diskussion über den Risikostrukturausgleich (RSA) zwischen den Gesetzlichen Krankenkassen konzentriert sich auf die Frage, ob zusätzlich Morbiditätsmerkmale berücksichtigt werden sollen. Vorliegende Studien deuten darauf hin, dass Kassenwechsler im Durchschnitt bessere Risiken sind. In diesem Beitrag werden die Determinanten des Kassenwechsels mit Daten des Sozio-oekonomischen Panels (SOEP) analysiert. Dabei zeigt sich, dass der Beitragssatz die entscheidende Determinante ist. Eine Steigerung des Beitragssatzes um einen Prozentpunkt erhöht die Wahrscheinlichkeit eines Wechsels im Durchschnitt um 4 Prozentpunkte. Einen positiven Einfluss auf die Wechselwahrscheinlichkeit hat auch das Erwerbseinkommen, allerdings nur bis zur Höhe der Beitragsbemessungsgrenze. Ältere Menschen wechseln hingegen weniger häufig die Krankenkasse. Im Hinblick auf die Inanspruchnahme von Leistungen des Gesundheitssystems sind die Ergebnisse nicht eindeutig: Während mit steigender stationärer Inanspruchnahme die Wahrscheinlichkeit eines Kassenwechsels abnimmt, zeigt sich für die ambulante Inanspruchnahme ein positiver Einfluss.

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    File URL: http://www.diw.de/documents/publikationen/73/diw_01.c.38505.de/dp267.pdf
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    Paper provided by DIW Berlin, German Institute for Economic Research in its series Discussion Papers of DIW Berlin with number 267.

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    Length: 22 p.
    Date of creation: 2001
    Date of revision:
    Handle: RePEc:diw:diwwpp:dp267
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    1. Moulton, Brent R, 1990. "An Illustration of a Pitfall in Estimating the Effects of Aggregate Variables on Micro Unit," The Review of Economics and Statistics, MIT Press, vol. 72(2), pages 334-38, May.
    2. Friedrich Breyer & Mathias Kifmann & Erika Schulz, 2001. "Risikostrukturausgleich am Scheideweg: Senkung der Wirtschaftlichkeitsanreize für die Krankenkassen sollte vermieden werden," DIW Wochenbericht, DIW Berlin, German Institute for Economic Research, vol. 68(14), pages 213-219.
    3. Johannes Schwarze & Hanfried H. Andersen & Silke Anger, 2000. "Self-Rated Health and Changes in Self-Rated Health as Predictors of Mortality: First Evidence from German Panel Data," Discussion Papers of DIW Berlin 203, DIW Berlin, German Institute for Economic Research.
    4. Friedrich Breyer & Mathias Kifmann, 2001. "Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV," Discussion Papers of DIW Berlin 236, DIW Berlin, German Institute for Economic Research.
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