The Effect of Private Health Insurance on Doctor Visits, Hospital Nights, and Self-Assessed Health: Evidence from the German Socio-Economic Panel

In Germany, employees are generally obliged to participate in the public health insurance system, where coverage is universal, co-payments and deductibles 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 deductibles and co-payments are common. In this paper, we estimate the effect of private insurance coverage on the number of doctor visits, the number of nights spent in a hospital, and self-assessed health. Variation in income around the compulsory insurance threshold provides a natural experiment that we use to control for selection into private insurance. We find negative effects of private insurance coverage on the number of doctor visits, no effects on the number of nights spent in a hospital, and positive effects on health.