Effects of Contribution Co- Payments on Health Care and Health Financing in the German Health Care System

Abstract

As part of the German Health Modernization Act (GMG), additional payments have been made for outpatient and inpatient medical services since 01.01.2004. In this study here, the effect of additional payments on the quality of care and efficiency is examined by considering various literature sources. The study is only limited to the additional forms of practice fees and prescription drug fees. The effects on the health system of contributions and the effects on patient behavior are investigated. The effects of increasing or decreasing additional payments on patient behavior are examined. These changes are examined with the moral hazard problem approach. Since the medical services burden the health system financially, the main goal of relieving the health system has not been achieved. The current co-payment reforms even lead to increased moral hazard behavior, since the insured person who pays the co-payment per quarter tends to benefit more often from medical services in the same quarter.

Keywords

• co-payments,consultation fee,moral hazard

Kaynakça

1. Kern AO, Kistler E, Mamberer F, Unteutsch RR, Martolock B, Wörner D (2004): Die Bestimmung des Leistungskataloges in der gesetzlichen Krankenversicherung- Definitionsprobleme und Implikationen von Leistungsausgrenzungen in der gesetzlichen Krankenversicherung. Düsseldorf. Edition der Hans Böckler Stiftung- Bd. 1
2. Wildmann L (2010): Einführung in die Volkswirtschaftslehre- Mikroökonomie und Wettbewerbspolitik. Oldenbourg Wissenschaftsverlag, 258
3. Augurzky B, Bauer T, Schaffner S(2007): Zeigt die Praxisgebühr die gewünschte Wirkung? Rheinisch-Westfälisches Institut für Wirtschaftsforschung (Hrsg.). Positionen #16. Essen
4. Augurzky B, Bauer TK, Schaffner S (2006): Copayments in the German Health System: Does It Work? Forschungsinstitut zur Zukunft der Arbeit- Institute for the Study of Labor/ Bonn
5. Chandra A, Gruber J, McKnight R (2010): Patient Cost Sharing in Low Income Populations. In: American Economic Review 100.2 (2010): 303-308. © 2011 AEA. The American Economic Association. http://hdl.handle.net/1721.1/61733,
6. Chandra A, Gruber J, McKnight R (2010): Patient Cost-Sharing and Hospitalization Offsets in the Elderly. In: Am Econ Rev. 2010 March 1; 100(1): 193–213
7. Costa-i-Font J, Gemmill-Toyama M (2010): Does Cost Sharing really Reduce Inappropriate Prescriptions? In: CESIFO WORKING PAPER NO. 3002, CATEGORY 3: SOCIAL PROTECTION.
8. Farbmacher, H (2009): Copayments for doctor visits in Germany and the probability of visiting a physician - Evidence from a natural experiment, Munich Discussion Paper No. 2009-10, URL: http://epub.ub.uni-muenchen.de/10951/

9. Gemmill MC, Thomson S, Mossialos E (2008): What impact do prescription drug charges have on efficiency and equity? Evidence from high-income countries. In: International Journal for Equity in Health, licensee BioMed Central Ltd. URL: http://www.equityhealthj.com/content/7/1/12
10. Gibson TB, Ozminkowski RJ, Goetzel RZ (2005): The Effects of Prescription Drug Cost Sharing: A Review of the Evidence. In: Am J Manag Care. 2005;11:730-740
11. Goldman DP, Joyce GF, Yuhui Zh.(2007): Prescription Drug Cost Sharing Associations With Medication and Medical Utilization and Spending and Health, Available at: http://works.bepress.com/dana_goldman/58, From the Selected Works of Dana Goldman, January 2007, JAMA. 2007;298(1):61-66
12. Grabka MM, Schreyögg J, Busse R (2005): Die Einführung der Praxisgebühr und ihre Wirkung auf die Zahl der Arztkontakte und die Kontaktfrequenz – eine empirische Analyse. German Institute for Economic Research (DIW Berlin). Diskussionspapier 506. Berlin
13. Gruber J (2006): The Role of Consumer Copayments for Health Care: Lessons from the RAND Health Insurance Experiment and Beyond. Prepared for the Kaiser Family Foundation by: Massachusetts Institute of Technology
14. Heisler M, Langa KM, Eby EL., Fendrick MA., Kabeto MU, Piette JD. (2004): The Health Effects of Restricting Prescription Medication Use Because of Cost. In: Medical Care - Volume 42, Number 7: 626–634
15. Hoh C, Honekamp I (2010) : Selbstbeteiligung als Lösung für das Moral- Hazard-Problem auf dem Arzneimittelmarkt? Lehrstuhl für Empirische Mikroökonomik-Fakultät Sozial-und Wirtschaftswissenschaften- Otto-Friedrich-Universität Bamberg/ MPRA Paper No. 27425. URL: http://mpra.ub.uni-muenchen.de/27425
16. Holst J (2004): Modalitäten und Effekte von Zuzahlungen im Gesundheitswesen. Klinikum der Johann Wolfgang Goethe-Universität, Frankfurt am Main-Zentrum der Psychosozialen Grundlagen der Medizin- Institut für Medizinische Soziologie/ Frankfurt
17. Kern, Axel Olaf; Freund, Florian; Mamberer, Florian; Langer, Bernhard; Pfaff, Anita B. (2003) : Zuzahlungen nach dem GKV-Modernisierungsgesetz (GMG) unter Berücksichtigung von Härtefallregelungen, Volkswirtschaftliche Diskussionsreihe. Institut für Volkswirtschaftslehre der Universität Augsburg, No. 253, http://hdl.handle.net/10419/22776,
18. Kraft S, Puschner B, Kordy H (2004): Gesundheitsökonomie in Psychotherapie und Psychiatrie -Inanspruchnahme medizinischer Gesundheitsleistungen vor Beginn einer ambulanten Psychotherapie. Vogel H (Hrsg.). Schattauer Verlag
19. Schreyögg J (2002): Medical Savings Accounts als Instrument zur Reduktion von moral hazard Verlusten bei der Absicherung des Krankheitsrisikos. Technische Universität Berlin, Fakultät Wirtschaft Und Management. Diskussionspapiere //No. 2002/5
20. Schreyögg J, Grabka MM (2009): Copayments for ambulatory care in Germany: a natural experiment using a difference-in- difference approach. In: Eur J Health Econ 11:331-341. Doi:10.1007/s10198-009-0179-9   Winkelmann R (2003): Co-payments for prescription drugs and the demand for doctor visits - Evidence from a natural experiment. University of Zurich, IZA Bonn and CEPR London
21. Winkelmann R (2003): Co-Payments For Prescription Drugs And The Demand For Doctor Visits - Evidence From A Natural Experiment. Iza Bonn And Cepr London
22. Winkelmann R (2006): Reforming Health Care: Evidence from Quantile Regressions for Counts. In: Journal of Health Economics 25 : 131–145
23. Zweifel P, Manning WG (2000): Moral hazard and consumer incentives in health care. In: Culyer AJ, Newhouse JP (ed.) (2000): Handbook of Health Economics. Volume 1, Number 1. Elsevier: Amsterdam, 409-459
24. www.bmg.de