What is the Impact of Duplicate Coverage on the Demand for Health Care in Germany?

Duplicate coverage involves those individuals who hold compulsory health insurance with the public sector and have additional coverage with the private sector. The additional insurance covers costs for outpatient and inpatient care, income loss and hospital daily allowances. The number of persons who took out additional coverage has been steadily increased. This increase can be linked to two main factors: the shortage in the benefits package and the introduction of the reform act (January the 1st 2004). Basically, members of the public insurance sector have to make co-payment of 10 percent for all health care services and drug prescription (maximum 2 percent of the annual pre-tax income). Costs of transportation and dental prosthesis have been also excluded from the benefits package. It uses the SOEP German database for estimate an demand model for health services, given the simultaneity of the choices to take duplicate coverage and the level of health services (measured like number of visits), we estimate a negative binomial model to measure the impact of the duplicate coverage on the health service demand, we also estimate a a Full Information Maximun Loglikelihood (FIML) known in this case as an Endogenous Switching Poisson Count Model and we compare this results with the standard maximum log likelihood (ML) estimators of the negative binomial model. The Results show that there is a positive difference on the level of health services demanded when there is a duplicate coverage. We found also that there is evidence to think that in Germany there is a feedback between duplicate coverage and the demand of health services.Health care, insurance, Germany

Was bedeutet es, eine private Krankenversicherung zu haben?

Elhewaihi M. What does it mean to have private health insurance coverage?. Bielefeld (Germany): Bielefeld University; 2008.The health insurance is one of the most important insurance concerning the public since it serves to protect insured individuals from potential financial loss. This has been based on the theory of expected utility and the assumption that people generally prefer to lower risk uncertainty. In the early 1960s, Arrow argued that because of the risk avoidance aspect, health insurance has been desirable. Nonetheless, the generous coverage of some health insurance scheme would create large moral hazard by which health insurance becomes undesirable (Pauly 1968). In countries of social security system, healthcare is mostly financed by public-based insurance. However, the private insurance sector has been considered as an alternative source of healthcare financing and a tool to enhance system capacity. Although it constitutes only a small share of the total healthcare expenditures, the existence of the (PHI) has become a matter of extensive debate. This debate backs to the ability of the private insurance sector to provide efficient healthcare while maintaining its profit motive. In Germany, health insurance is provided by the statutory and the private sectors. While the statutory health insurance (SHI) sector provides two types of insurance, compulsory and voluntary, the private health insurance (PHI) sector offers only voluntary health insurance. The compulsory health insurance of the (SHI) is obligatory for people whose annual pre-tax income is below the income ceiling limit (Versicherungspflichtgrenze). Individuals whose annual pre-tax income is above the income ceiling limit are eligible for the voluntary health insurance. The demand for (PHI) in Germany has been growing; alone in 2004 around 400.000 individuals chose one of the (PHI) coverage schemes. The arguments standing behind this growing demand have mostly focused on three possible factors: the high contribution rates of the (SHI) sector, the individual's level of income and the quality gap in healthcare between both insurance sectors. This study has been undertaken to verify these arguments. This work seeks to find out the relationships between the individual's type of health insurance and the non-medical aspects of healthcare. The study raises the following questions: 1) Is there a quality gap in healthcare between both insurance sectors, in other words we want to figure out how individuals of both insurance sectors perceive the quality of healthcare? 2) Do the privately insured individuals enjoy more privileges than the statutory insured individuals? And 3) what possible factors can be linked to the individual's type of health insurance. For examining these issues, the study uses the cross-sectional design, which addresses contemporaneous measurements of the study cases within a narrow time span. Using telephone interviews, data are collected from 150 randomly selected individuals on the pattern of healthcare utilization, the type of health insurance, the health status as well as the socio-economic characteristics