Copayments in the German Health System: Does It Work? (original) (raw)

Cost-sharing in the German health care system

Discussion Papers, 2004

In Germany, cost-sharing for health care has been used as a financing mechanism since 1923. In this article, the historical development of user charges in Germany since the 1980s is presented in more detail by type of private expenditure, including direct payments, cost-...

Financial incentives in the German Statutory Health Insurance: New findings, new questions

Health Policy, 2010

Objectives: This paper presents findings of a mandatory three-year evaluation of a prevention bonus scheme offered in the German Statutory Health Insurance (SHI). Its objective is to describe the rationale behind the programs, analyze their financial impact and discuss their implications on potentially conflicting goals on solidarity and competition. Methods: The analysis included 70,429 insured enrolled in a prevention bonus program in a cohort study. The intervention group and their matched controls were followed for a three-year period. Matching was performed as nearest neighbor matching. The economic analysis comprised all costs relevant for Sickness Funds (SF) in the SHI and was carried out from a SHI perspective. Differences in cost trends between the intervention and the control group were examined applying the paired t-test. Results: Regarding mean costs there was a significant difference between the two groups of D 177.48 (90% CI [D 149.73; D 205.24]) in favor of the intervention group. If program costs were considered cost reductions of D 100.88 (90% CI [D 73.12; D 128.63]) were obtained. Conclusions: The uptake of a prevention bonus program led to cost reductions in the intervention group compared to the control group even when program costs were considered. However, the results must be interpreted with caution as in addition to financial aspects, socio-economic and health-status, selection bias and the function and use of bonus programs as marketing tools, as well as their long-term sustainability should be considered in future assessments.

The Effect of Copayments on Children’s and Adolescents’ Use of Medical Care

2015

We exploit a policy change in Sweden to estimate the effect of cost-sharing on the demand for children’s and adolescents’ use of medical care. To this end, we use a large population-wide registry data set including detailed information about individuals and their contacts with the health care system. The reform we study was unexpected and came into effect in January 2002. It abolished copayments in outpatient care for children between 7 and 19 years. We estimate a difference-in-differences model using age groups slightly younger and slightly older as controls. When care became free of charge, we find that individuals increased their number of visits to a doctor by 5-10 percent. Effects are similar across age groups but vary substantially by income, with children from lowincome families being three times as responsive as their more advantaged peers. We also exploit the fact that copayments charged changed discontinuously at age 7 before the reform and at age 20 after the reform. Esti...

Fees for outpatient operations in Germany: development, evaluation and European comparison

Ambulatory Surgery, 2000

In Germany, discussions on the fees for statutory sickness insurance for ambulatory surgery has, in the last few years, become almost a symbol of dispute for the German health services. Outpatient surgeons complain about the fact that the fees do not cover their services. They see innovation severely threatened by bureaucracy, profitability by planned economy, rights by reasons of State, aggravated by the 'reform' attempts of the Greens and Socialist coalition Federal Government. On the other hand their opponents complain about the money mindedness of the doctors. Intentional panic or real disaster? The fundamental consideration to clarify this question is based on a comparison of the German statutory medical insurance fees and private fees with our neighbours. In Europe an economic area with similar prices for goods, services and wages, even 'outpatient operations' services with comparable cost rates should be paid for at a corresponding level. Any discrepancies would give cause to look for an explanation by analysing the historic development of fees and the question of a fair comparison between operations and the non-operative services.

A Comparison of the Burden of Out-of-Pocket Health Payments in Denmark, Germany and Poland

2017

It is important to monitor equity of access to health services in all countries. We assessed the levels of out-of-pocket (OOP) health spending in three European countries: Denmark, Germany and Poland. Using data from national databases (i.e., Statistics Denmark, German Socio-Economic Panel, and National Statistical Office of Poland) for the period 2000–2010, we applied common methods to assess the rate of households with ‘catastrophic’ OOP health spending and the concentration of health spending in income-ordered groups of citizens. 20.3 per cent of Polish households experienced ‘catastrophic’ expenditure defined by OOP health spending/income ratio >10 per cent, compared to 1.0 per cent of households in Germany and 3.2 per cent of households in Denmark. 8.8 per cent of Polish households experienced ‘catastrophic’ expenditure defined by OOP health spending/capacity to pay ratio >40 per cent, compared to 0.4 per cent of households in Germany and 0.8 per cent of households in Den...

Changing Long-established Structures for More Competition and Stronger CoordinationHealth Care Reform in Germany in the New Millennium

Intereconomics, 2008

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden. Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen. Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in EconStor may be saved and copied for your personal and scholarly purposes. You are not to copy documents for public or commercial purposes, to exhibit the documents publicly, to make them publicly available on the internet, or to distribute or otherwise use the documents in public. If the documents have been made available under an Open Content Licence (especially Creative Commons Licences), you may exercise further usage rights as specified in the indicated licence.