期刊名称：DIW Diskussionspapiere / Deutsches Institut für Wirtschaftsforschung, Berlin
出版年度：2008
卷号：2008
出版社：Deutsches Institut für Wirtschaftsforschung, Berlin
摘要：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.
关键词：copayments, ambulatory care, difference-in-difference, count data,
zero-inflated-model
