gms | German Medical Science

Background: While the aim of universal health coverage in Germany is to provide equal access to health care, differences in health care accessibility and waiting time have been observed based on the type of health insurance coverage that patients have. Health insurance in Germany can be categorized into two schemes- statutory health insurance or private health insurance, and better coverage and higher profitability associated with private health insurance may pose a financial incentive for physicians to give preferential treatment to privately insured patients. This study aims to contribute to previous work through analyzing several measures of waiting time for inpatients as well as the influence of hospital-level indicators.

Research Questions: The objective of this study is to examine the effect of health insurance type on waiting time, particularly when the share of privately insured patients in the hospital is taken into account. Are there significant differences in waiting time between privately insured breast cancer patients and patients with statutory insurance? And given the limited nature of resources and time, is the effect of insurance status on waiting time smaller in hospitals that have higher shares of privately insured patients?

Methods: This study utilizes cross-sectional data from 2017 of breast cancer patients. Data was collected through a mail survey of breast cancer patients who underwent surgery in one of the certified breast cancer centers in one German state, as part of a yearly patient survey used to certify breast cancer centers. The survey is designed based on the Dillmann Total Design Method, with an 88.94% response rate (N=4626) in 2017.

Results: Results from multilevel logistic regression models indicate a significant effect of health insurance status and waiting time, net of other relevant factors (patient’s sociodemographic background, self-reported health, type of surgery, and tumor stage). Patients with statutory insurance were significantly more likely than privately insured patients to report long waiting times for examinations/procedures, discharge, nursing staff, and to speak with the physician. Moreover, health insurance status is the only significant explanation for differences in self-reported waiting time. The share of privately insured breast cancer patients in the hospital, however, did not influence overall waiting time or the individual effect of health insurance on waiting time.

Discussion: Results suggest a private health insurance advantage, with private patients given priority to health care services.

Practical Implications: Disparities in health care accessibility and quality need to continue to be addressed and discussed, as well as the impact of health insurance type on other indicators of health care.