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

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  • Hullegie P
  • Klein TJ

Abstract

In Germany, employees are generally obliged to participate in the public health insurance system, where coverage is universal, co-payments and deductables 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 deductables and co-payments are common. In this paper we estimate the effect of private insurance coverage on the number of doctor visits 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 and positive effects on health.

Suggested Citation

  • Hullegie P & Klein TJ, 2009. "The effect of private health insurance on medical care utilization and self-assessed health in Germany," Health, Econometrics and Data Group (HEDG) Working Papers 09/17, HEDG, c/o Department of Economics, University of York.
  • Handle: RePEc:yor:hectdg:09/17
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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. 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.
    3. YANAGI, Takahide, 2015. "Regression Discontinuity Designs with Nonclassical Measurement Error," Discussion Papers 2015-09, Graduate School of Economics, Hitotsubashi University.
    4. Bernal Lobato, N., 2014. "Essays in applied microeconomics," Other publications TiSEM 9b638b3d-2f83-452a-b2c8-c, Tilburg University, School of Economics and Management.
    5. Takahide Yanagi, 2014. "The Effect of Measurement Error in the Sharp Regression Discontinuity Design," KIER Working Papers 910, Kyoto University, Institute of Economic Research.
    6. Bonsang, Eric & Klein, Tobias J., 2012. "Retirement and subjective well-being," Journal of Economic Behavior & Organization, Elsevier, pages 311-329.
    7. 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).
    8. repec:eee:joecag:v:6:y:2015:i:c:p:24-43 is not listed on IDEAS
    9. 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.
    10. 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.
    11. 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.
    12. 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.
    13. repec:eee:pubeco:v:154:y:2017:i:c:p:122-136 is not listed on IDEAS
    14. 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.
    15. 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).
    16. repec:dau:papers:123456789/9533 is not listed on IDEAS
    17. repec:spr:stpapr:v:58:y:2017:i:4:d:10.1007_s00362-016-0745-z is not listed on IDEAS
    18. repec:zbw:rwirep:0458 is not listed on IDEAS
    19. 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.
    20. 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.
    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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