gms | German Medical Science

10. Deutscher Kongress für Versorgungsforschung, 18. GAA-Jahrestagung

Deutsches Netzwerk Versorgungsforschung e. V.
Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e. V.

20.-22.10.2011, Köln

Heterogeneous effects of the 2004 health care reform

Meeting Abstract

10. Deutscher Kongress für Versorgungsforschung. 18. GAA-Jahrestagung. Köln, 20.-22.10.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. Doc11dkvf115

doi: 10.3205/11dkvf115, urn:nbn:de:0183-11dkvf1158

Veröffentlicht: 12. Oktober 2011

© 2011 Farbmacher et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Background: The health care reform of 2004 was intended to reduce moral hazard in the statutory health insurance through various financial incentives. An important element of the reform has been the introduction of a per-quarter fee for doctor visits. The second part of the reform has been an increase in prescription fees. Additionally, the reform has abolished the possibility to prescribe over the counter medications and the sickness funds no longer pay for eyeglasses and visual aids. The aim of the study is to explore the impact of the reform on changes in health care utilization, especially whether the percentage of patients seeing a doctor diminishes in 2004 compared to the years before and how the utilization pattern develops further on.

Materials and methods: Database: Statutory health insurance sample of the AOK Hesse/KV Hesse, allowing to reliably observe physician visits. Study population: roughly 250,000 insured individuals in each calendar quarter. Observation period: 2002 to 2005. The data includes information about the type of doctors visits (general practitioner; other specialists). This allows us to analyze whether the reform has had differential effects on these two types of doctor visits. Furthermore, the data set only includes few individuals who are generally exempt from copayments and could thus serve as a control group (e.g. the youths). We therefore revert to before-after comparisons to identify the effects of the reform. Our results thus rely on the assumption that in the absence of the reform changes in health care use would not have occurred or at least these changes are not considerably large. First, we compare the percentage of patients with any physician contact for each quarter of the observation period. Second, we develop a finite mixture bivariate Probit model to investigate whether the reform has had heterogeneous effects.

Results: The probability to visit any kind of doctor at least once within a quarter decreases by about 3 percentage points after the increase in copayments. Distinguishing the results between GP and specialist visits shows that the probability of at least one GP visit decreases slightly less than the probability of at least one specialist visit. Furthermore, we can distinguish two underlying groups: likely users who react less to the increase in copayments and less-likely users who show a strong reduction in the probability to visit a doctor.

Conclusions: The reform has had an effect on patients' behavior. But not all insured persons have an equal chance to avoid physician contacts as demonstrated with the two user groups. This result aligns with findings in the literature that the demand for health care is more elastic among low users of health care than among high users. Claims data are a valuable source for impact research, but further analysis should include socio-demographic information on the insured persons in order to gain a better picture on determinants of health care utilization behavior.