Schreyoegg, Jonas and Grabka, Markus M (2008): Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach. Published in: DIW Berlin, Discussion Paper, No. 777
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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.
|Item Type:||MPRA Paper|
|Original Title:||Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach|
|Keywords:||copayments, ambulatory care, difference-in-difference, count data, zeroinflated- model|
|Subjects:||C - Mathematical and Quantitative Methods > C1 - Econometric and Statistical Methods and Methodology: General > C13 - Estimation: General
I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy; Regulation; Public Health
L - Industrial Organization > L3 - Nonprofit Organizations and Public Enterprise > L31 - Nonprofit Institutions; NGOs
|Depositing User:||Jonas Schreyoegg|
|Date Deposited:||05. Jun 2010 18:50|
|Last Modified:||18. Feb 2013 15:29|
Association of Private Health Insurance (Verband der Privaten Krankenversicherer (PKV). Die private Krankenversicherung. Zahlenbericht 2006/2007. Köln, 2007.
Beck RG, Horne JM. Utilization of Publicly Insured Health Services in Saskatchewan before, during and after Copayment. Medical Care 1980;18: 787-806.
Blundell R, Costa Dias M. Alternative approaches to evaluation in empirical microeconomics. Cemmap Working Papers CWP10/02. Available at http://cemmap.ifs.org.uk/wps/cwp0210.pdf, 2002.
Cherkin DC, Grothaus L, Wagner EH. The effect of office visit copayments on preventive care services in an HMO. Inquiry 1990; 27: 24-38.
Elofsson S, Unden AL, Krakau I. Patient charges - a hindrance to financially and psychosocially disadvantage groups seeking care. Social science and medicine 1998; 46: 1375-1380.
Federal Ministry of Health (Bundesministerium für Gesundheit). Gesetzliche Krankenversicherung. Mitglieder, mitversicherte Angehörige, Beitragssätze und Krankenstand. Bonn, 2007.
GEK-Gmünder Ersatzkasse. GEK-report ambulant-ärztliche Versorgung. Auswertungen der GEK-Gesundheitsberichterstattung. Asgard-Verlag: Sankt Augustin, 2006.
Greene W. Accounting for Excess Zeros and Sample Selection in Poisson and Negative Binomial Regression Models. Stern School of Business Working Paper 1994, EC-94-10.
Grootendorst PV. A comparison of alternative models of prescription drug utilization. Health Economics 1995; 4: 183–198.
Jones AM. Health econometrics. In Handbook of Health Economics, Culyer AJ, Newhouse JP (eds). Elsevier: Amsterdam, 2000; Chapter 13.
Lambert D. Zero-inflated Poisson regression with an application to defects in manufacturing. Technometrics 1992; 34: 1–14.
Manning WG, Newhouse JN, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the demand for medical care: evidence from a randomized experiment. American Economic Review 1987; 77: 251-77.
Roemer MI, Hopkins CE, Carr L, Gartside F. Copayments for Ambulatory Care : Penny- Wise and Pound-Foolish. Medical Care 1975; 13: 457-466.
Sheu ML, Hu TW, Keeler TE, Ong M, Sung HY. The effect of a major cigarette price change on smoking behaviour in California: a zero-inflated negative binomial model. Health Economics 2004; 13: 781-791.
Scitovsky, AA., McCall, N. Coinsurance and the Demand for Physician Services: Four Years Later. Social Security Bulletin 1977; 35: 4019-27.
Vuong QH. Likelihood Ratio Tests for Model Selection and Non-Nested Hypotheses. Econometrica 1989; 57: 307-333.
Wagner, GG, Frick, JR, Schupp, J. The German Socio-Economic Panel Study (SOEP) – Evolution, Scope and Enhancements. Schmoller’s Jahrbuch – Journal of Applied Social Science Studies 2007;127: 139-170.
Winkelmann R. Co-payments for prescription drugs and the demand for doctor visits – evidence from a natural experiment. Health Economics 2004; 13:1081-1089.
Wooldridge JM. Econometric Analysis of Cross Section and Panel Data. The MIT Press: Cambridge, MA, 2002.
World Health Organization. Health for all Database. 2008.
Yau KKW, Wang K, Lee AH. Zero-Inflated Negative Binomial Mixed Regression Modeling of Over-Dispersed Count Data with Extra Zeros. Biometrica 2003;45: 437-452.
Zhang J. A DiD Analysis of the Impact of Health Insurance Reform in the City of Hangzhou. Health Economics 2007;16: 1389-140