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

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  • Schreyoegg, Jonas
  • Grabka, Markus M

Abstract

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.

Suggested Citation

  • Schreyoegg, Jonas & Grabka, Markus M, 2008. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," MPRA Paper 23035, University Library of Munich, Germany.
  • Handle: RePEc:pra:mprapa:23035
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    References listed on IDEAS

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    1. 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.
    2. repec:spr:portec:v:1:y:2002:i:2:d:10.1007_s10258-002-0010-3 is not listed on IDEAS
    3. Richard Blundell & Monica Costa Dias, 2009. "Alternative Approaches to Evaluation in Empirical Microeconomics," Journal of Human Resources, University of Wisconsin Press, vol. 44(3).
    4. Vuong, Quang H, 1989. "Likelihood Ratio Tests for Model Selection and Non-nested Hypotheses," Econometrica, Econometric Society, vol. 57(2), pages 307-333, March.
    5. Andrew M. Jones, 2012. "health econometrics," The New Palgrave Dictionary of Economics, Palgrave Macmillan.
    6. 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.
    7. Augurzky, Boris & Bauer, Thomas K. & Schaffner, Sandra, 2006. "Copayments in the German Health System - Do They Work?," RWI Discussion Papers 43, RWI - Leibniz-Institut für Wirtschaftsforschung.
    8. 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.
    9. Gert G. Wagner & Joachim R. Frick & Jürgen Schupp, 2007. "The German Socio-Economic Panel Study (SOEP) – Scope, Evolution and Enhancements," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 127(1), pages 139-169.
    10. 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, April.
    11. 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.
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    Cited by:

    1. Janet Vroomen & Peter Zweifel, 2011. "Preferences for health insurance and health status: does it matter whether you are Dutch or German?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(1), pages 87-95, February.
    2. Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing regional variation in health care utilization using (rich) household microdata," Health Policy, Elsevier, vol. 114(1), pages 41-53.
    3. Helmut Farbmacher & Peter Ihle & Ingrid Schubert & Joachim Winter & Amelie Wuppermann, 2017. "Heterogeneous Effects of a Nonlinear Price Schedule for Outpatient Care," Health Economics, John Wiley & Sons, Ltd., vol. 26(10), pages 1234-1248, October.
    4. Johannes S. Kunz & Rainer Winkelmann, 2017. "An Econometric Model of Healthcare Demand With Nonlinear Pricing," Health Economics, John Wiley & Sons, Ltd., vol. 26(6), pages 691-702, June.
    5. Paloyo, Alfredo R., 2009. "Co-pay and Feel Okay: Evidence of Illusory Health Gains from a Health Insurance Reform," Ruhr Economic Papers 142, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    6. Wuppermann, Amelie Catherine, 2011. "Empirical Essays in Health and Education Economics," Munich Dissertations in Economics 13187, University of Munich, Department of Economics.
    7. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    8. Laura Romeu Gordo & Andreas Motel-Klingebiel & Susanne Wurm, 2009. "SOEP as a Source for Research on Ageing: Issues, Measures and Possibilities for Improvement," SOEPpapers on Multidisciplinary Panel Data Research 173, DIW Berlin, The German Socio-Economic Panel (SOEP).
    9. Galina Besstremyannaya, 2012. "Heterogeneous effect of coinsurance rate on the demand for health care: a finite mixture approach," Working Papers w0163, Center for Economic and Financial Research (CEFIR).
    10. Poulsen, Camilla Aavang, 2014. "Introducing out-of-pocket payment for General Practice in Denmark: Feasibility and support," Health Policy, Elsevier, vol. 117(1), pages 64-71.
    11. Zasimova, Liudmila & Kossova, Elena, 2016. "Empirical analysis of out-of-pocket expenditures on medicine in Russia," Applied Econometrics, Publishing House "SINERGIA PRESS", vol. 42, pages 75-99.
    12. Jakobsson, Niklas & Svensson, Mikael, 2016. "Copayments and physicians visits: A panel data study of Swedish regions 2003–2012," Health Policy, Elsevier, vol. 120(9), pages 1095-1099.
    13. Rainer Winkelmann, 2014. "An Empirical Model of Health Care Demand under Non-linear Pricing," SOEPpapers on Multidisciplinary Panel Data Research 688, DIW Berlin, The German Socio-Economic Panel (SOEP).
    14. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    15. Helmut Farbmacher; & Joachim Winter, 2012. "Non-linear price schedules, demand for health care and response behavior," Health, Econometrics and Data Group (HEDG) Working Papers 12/15, HEDG, c/o Department of Economics, University of York.
    16. Nicolas Ziebarth, 2014. "Assessing the effectiveness of health care cost containment measures: evidence from the market for rehabilitation care," International Journal of Health Economics and Management, Springer, vol. 14(1), pages 41-67, March.
    17. Jana Votapkova & Pavlina Zilova, 2016. "The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    18. Stefanie Schubert, 2014. "Reducing public health insurance expenditure: a numerical analysis for Germany," Applied Economics, Taylor & Francis Journals, vol. 46(19), pages 2228-2241, July.
    19. Ha Trong Nguyen & Luke B Connelly, 2017. "Cost-sharing in health insurance and its impact in a developing country: evidence from a quasi-natural experiment," Bankwest Curtin Economics Centre Working Paper series WP1702, Bankwest Curtin Economics Centre (BCEC), Curtin Business School.
    20. Farbmacher, Helmut, 2009. "Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment," Discussion Papers in Economics 10951, University of Munich, Department of Economics.

    More about this item

    Keywords

    copayments; ambulatory care; difference-in-difference; count data; zeroinflated- model;

    JEL classification:

    • C13 - Mathematical and Quantitative Methods - - Econometric and Statistical Methods and Methodology: General - - - Estimation: General
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L31 - Industrial Organization - - Nonprofit Organizations and Public Enterprise - - - Nonprofit Institutions; NGOs; Social Entrepreneurship

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