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Copayments in the German Health System - Do They Work?

Author

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  • Augurzky, Boris
  • Bauer, Thomas K.
  • Schaffner, Sandra

Abstract

This paper examines the effect of copayments on doctor visits using the German health care reform of 2004 as a natural experiment. In January 2004, copayments of 10 euros for the first doctor visit in each quarter have been introduced for all adults in the statutory health insurance. Individuals covered by private health insurance as well as youths have been exempted from these copayments. We use them as control groups in a difference-in-differences approach to identify the causal impact of these copayments on doctor visits. In contrast to expectations and public opinion our results indicate that there are no statistically significant effects of the copayments on the decision of visiting a doctor.

Suggested Citation

  • 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.
    • Handle: RePEc:zbw:rwidps:43
    as

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    Cited by:

    1. repec:zbw:rwirep:0046 is not listed on IDEAS
    2. Augurzky, Boris & Tauchmann, Harald, 2011. "Less social health insurance, more private supplementary insurance? Empirical evidence from Germany," Journal of Policy Modeling, Elsevier, vol. 33(3), pages 470-480, May.
    3. Alfredo R. Paloyo, 2014. "Co-Pay and Feel Okay: Self-Rated Health Status After a Health Insurance Reform," Social Science Quarterly, Southwestern Social Science Association, vol. 95(2), pages 507-522, June.
    4. Boris Augurzky & Harald Tauchmann, 2008. "Less Social Health Insurance – More Private Supplementary Insurance? – Empirical Evidence from Germany," Ruhr Economic Papers 0046, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    5. 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 and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 11(3), pages 331-341.
    6. 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.
    7. Eibich, Peter & Ziebarth, Nicolas R., 2014. "Analyzing Regional Variation in Health Care Utilization Using (Rich) Household Microdata," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 114(1), pages 41-53.
    8. Mingming Xu & Benjamin Bittschi, 2022. "Does the abolition of copayment increase ambulatory care utilization?: a quasi-experimental study in Germany," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(8), pages 1319-1328, November.
    9. 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).
    10. Philipp Breidenbach, 2015. "Expansions of Regional Airports and their Effect on the Local Economy," ERSA conference papers ersa15p1196, European Regional Science Association.
    11. 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.
    12. 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.
    13. Jan Zápal, 2010. "Doctor-Visit Co-Payment Exemption for Children: First Look at the Data," Czech Journal of Economics and Finance (Finance a uver), Charles University Prague, Faculty of Social Sciences, vol. 60(1), pages 58-72, February.
    14. Himmel, Konrad & Schneider, Udo, 2017. "Ambulatory care at the end of a billing period," hche Research Papers 14, University of Hamburg, Hamburg Center for Health Economics (hche).
    15. Helmut Farbmacher & Joachim Winter, 2013. "Per‐Period Co‐Payments And The Demand For Health Care: Evidence From Survey And Claims Data," Health Economics, John Wiley & Sons, Ltd., vol. 22(9), pages 1111-1123, September.
    16. Wuppermann, Amelie Catherine, 2011. "Empirical Essays in Health and Education Economics," Munich Dissertations in Economics 13187, University of Munich, Department of Economics.
    17. 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.
    18. 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.
    19. Raffelhüschen, Bernd & Moog, Stefan, 2010. "Ehrbarer Staat? Die Generationenbilanz. Update 2010: Handlungsoptionen der Gesundheitspolitik," Argumente zur Marktwirtschaft und Politik 111, Stiftung Marktwirtschaft / The Market Economy Foundation, Berlin.

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    More about this item

    Keywords

    Copayment; doctor visits; difference-in-differences; fixed-effect logit;
    All these keywords.

    JEL classification:

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

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