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Copayments in the German Health System: Does It Work?

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  • Augurzky, Boris

    (RWI)

  • Bauer, Thomas K.

    (RWI)

  • Schaffner, Sandra

    (RWI)

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: Does It Work?," IZA Discussion Papers 2290, Institute of Labor Economics (IZA).
    • Handle: RePEc:iza:izadps:dp2290
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    References listed on IDEAS

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    1. Marcus Tamm & Harald Tauchmann & Jürgen Wasem & Stefan Greß, 2007. "Elasticities of market shares and social health insurance choice in germany: a dynamic panel data approach," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 243-256, March.
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    Cited by:

    1. Hendrik Schmitz, 2012. "More health care utilization with more insurance coverage? Evidence from a latent class model with German data," Applied Economics, Taylor & Francis Journals, vol. 44(34), pages 4455-4468, December.
    2. Alfredo R. Paloyo, 2009. "Co-pay and Feel Okay: Evidence of Illusory Health Gains from a Health Insurance Reform," Ruhr Economic Papers 0142, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    3. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    4. repec:zbw:rwirep:0142 is not listed on IDEAS
    5. 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.
    6. 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.
    7. Paloyo, Alfredo R., 2009. "Co-pay and Feel Okay: Evidence of Illusory Health Gains from a Health Insurance Reform," Ruhr Economic Papers 142, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    8. 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).
    9. repec:zbw:rwirep:0076 is not listed on IDEAS
    10. Schmitz, Hendrik, 2008. "Do Optional Deductibles Reduce the Number of Doctor Visits? – Empirical Evidence with German Data," Ruhr Economic Papers 76, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    11. Jana Votapkova & Pavlina Zilova, 2016. "The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    12. 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.
    13. Hendrik Schmitz, 2008. "Do Optional Deductibles Reduce the Number of Doctor Visits? – Empirical Evidence with German Data," Ruhr Economic Papers 0076, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    14. 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.
    15. Stefanie Schubert, 2014. "Reducing public health insurance expenditure: a numerical analysis for Germany," Applied Economics, Taylor & Francis Journals, vol. 46(19), pages 2228-2241, July.
    16. 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.
    17. Hirotaka Kato & Rei Goto & Taishi Tsuji & Katsunori Kondo, 2022. "The effects of patient cost-sharing on health expenditure and health among older people: Heterogeneity across income groups," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(5), pages 847-861, July.
    18. Thönnes, Stefanie, 2015. "Do Deductibles reduce Moral Hazard in the German Statutory Health Insurance? - Empirical Evidence," VfS Annual Conference 2015 (Muenster): Economic Development - Theory and Policy 112912, Verein für Socialpolitik / German Economic Association.
    19. Astrid Kiil & Kurt Houlberg, 2014. "How does copayment for health care services affect demand, health and redistribution? A systematic review of the empirical evidence from 1990 to 2011," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(8), pages 813-828, November.
    20. Hendrik Schmitz, 2008. "Do Optional Deductibles Reduce the Number of Doctor Visits?: Empirical Evidence with German Data," SOEPpapers on Multidisciplinary Panel Data Research 141, DIW Berlin, The German Socio-Economic Panel (SOEP).
    21. Wuppermann, Amelie Catherine, 2011. "Empirical Essays in Health and Education Economics," Munich Dissertations in Economics 13187, University of Munich, Department of Economics.
    22. 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.
    23. 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.
    24. 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:

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

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