Non-linear price schedules, demand for health care and response behavior
When health insurance reforms involve non-linear price schedules tied to payment periods (for example, a quarter or a year), the empirical analysis of its effects has to take the within-period time structure of incentives into account. The analysis is further complicated when demand data are obtained from a survey in which the reporting period does not coincide with the payment period. We illustrate these issues using as an example a health care reform in Germany which imposed a perquarter fee of e10 for doctor visits and additionally set an out-of-pocket maximum. This co-payment structure results in an effective "spot" price for a doctor visit which decreases over time within each payment period. Using this variation, we find a substantial effect of the new fee, in contrast to earlier studies of this reform. Overall, the probability of visiting a physician decreased by around 2.5 percentage points in response to the new fee for doctor visits. We verify the key assumptions of our approach using a separate data set of insurance claims in which the reporting period effects are absent by construction.
|Date of creation:||Jul 2012|
|Date of revision:|
|Contact details of provider:|| Postal: HEDG/HERC, Department of Economics and Related Studies, University of York, York, YO10 5DD, United Kingdom|
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- Jonas Schreyögg & Markus Grabka, 2010.
"Copayments for ambulatory care in Germany: a natural experiment using a difference-in-difference approach,"
The European Journal of Health Economics,
Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 11(3), pages 331-341, June.
- Schreyögg, Jonas & Grabka, Markus M., 2010. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," EconStor Open Access Articles, ZBW - German National Library of Economics, pages 331-341.
- 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.
- Jonas Schreyögg & Markus M. Grabka, 2008. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," SOEPpapers on Multidisciplinary Panel Data Research 96, DIW Berlin, The German Socio-Economic Panel (SOEP).
- Jonas Schreyögg & Markus M. Grabka, 2008. "Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach," Discussion Papers of DIW Berlin 777, DIW Berlin, German Institute for Economic Research.
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11-007, Stanford Institute for Economic Policy Research.
- Aviva Aron-Dine & Liran Einav & Amy Finkelstein & Mark R. Cullen, 2012. "Moral Hazard in Health Insurance: How Important Is Forward Looking Behavior?," NBER Working Papers 17802, National Bureau of Economic Research, Inc.
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- Rainer Winkelmann, 2003.
"Co-Payments for Prescription Drugs and the Demand for Doctor Visits - Evidence from a Natural Experiment,"
SOI - Working Papers
0307, Socioeconomic Institute - University of Zurich.
- Rainer Winkelmann, 2004. "Co-payments for prescription drugs and the demand for doctor visits - Evidence from a natural experiment," Health Economics, John Wiley & Sons, Ltd., vol. 13(11), pages 1081-1089.
- 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.
- Amanda E. Kowalski, 2009. "Censored Quantile Instrumental Variable Estimates of the Price Elasticity of Expenditure on Medical Care," NBER Working Papers 15085, National Bureau of Economic Research, Inc.
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