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Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment

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  • Werbeck, Anna

    (RWI)

  • Wübker, Ansgar

    (RWI)

  • Ziebarth, Nicolas R.

    (ZEW)

Abstract

Using a randomized field experiment, we show that health care specialists cream-skim patients by their expected profitability. In the German two-tier system, outpatient reimbursement rates for both public and private insurance are centrally determined but are more than twice as high for the privately insured. In our field experiment, following a standardized protocol, the same hypothetical patient called 991 private practices in 36 German counties to schedule appointments for allergy tests, hearing tests and gastroscopies. Practices were 7% more likely to offer an appointment to the privately insured. Conditional on being offered an appointment, wait times for the publicly insured were twice as long than for the privately insured. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.

Suggested Citation

  • Werbeck, Anna & Wübker, Ansgar & Ziebarth, Nicolas R., 2020. "Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment," IZA Discussion Papers 13100, Institute of Labor Economics (IZA).
  • Handle: RePEc:iza:izadps:dp13100
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    Cited by:

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    2. Bach-Mortensen, Anders Malthe & Goodair, Benjamin & Barlow, Jane, 2022. "Outsourcing and children's social care: A longitudinal analysis of inspection outcomes among English children's homes and local authorities," Social Science & Medicine, Elsevier, vol. 313(C).
    3. Anell, Anders & Dackehag, Margareta & Dietrichson, Jens & Ellegård, Lina Maria & Kjellsson, Gustav, 2022. "Better Off by Risk Adjustment? Socioeconomic Disparities in Care Utilization in Sweden Following a Payment Reform," Working Papers 2022:15, Lund University, Department of Economics, revised 12 Mar 2024.
    4. Rudi Rocha & Maíra Coube Salmen & Tatiana Lima & Fábio Miessi & Rodrigo Moreno-Serra & Matías Mrejen & Beatriz Rache & Rodrigo R. Soares & Mônica Viegas, 2021. "Considerações sobre a Reforma da Lei dos Planos de Saúde e seus Possíveis Impactos sobre o SUS," Technical Notes 024, Instituto de Estudos para Políticas de Saúde.
    5. Luca Fumarco & Benjamin Harrell & Patrick Button & David Schwegman & E Dils, 2020. "Gender Identity, Race, and Ethnicity-based Discrimination in Access to Mental Health Care: Evidence from an Audit Correspondence Field Experiment," NBER Working Papers 28164, National Bureau of Economic Research, Inc.
    6. Sylvain Chareyron & Yannick L’Horty & Pascale Petit, 2023. "Cream skimming and discrimination in access to medical care: A field experiment," Health Economics, John Wiley & Sons, Ltd., vol. 32(8), pages 1868-1883, August.
    7. Juan Pablo Atal & Hanming Fang & Martin Karlsson & Nicolas R. Ziebarth, 2020. "German Long-Term Health Insurance: Theory Meets Evidence," NBER Working Papers 26870, National Bureau of Economic Research, Inc.
    8. Heisig, Jan Paul, 2021. "Soziale Ungleichheit und gesundheitliches Risiko in der Pandemie," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, pages 332-344.

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    More about this item

    Keywords

    allergy test; audiometry; gastroscopy; cherry picking; discrimination; health care access; reimbursement rates; health care inequality; allergists; otorhinolaryngologist; gastroenterologist;
    All these keywords.

    JEL classification:

    • I14 - Health, Education, and Welfare - - Health - - - Health and Inequality
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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