title: Accessing a new medication in Germany: a novel approach to assess a health insurance-related barrier.
abstract: OBJECTIVE
  Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies.
  
  
  METHODS
  The authors developed a novel three-dimensional person-time-related hurdle model and followed a cohort of 7358 statutorily (SHI) and 457 privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second to fourth year of the HealthCare Structural Reform Act in Germany.
  
  
  RESULTS
  For SHI compared with PHI migraine patients, there was a hurdle to receiving sumatriptan at all (2.4-fold lower hazard, 95% confidence interval, 1.8-3.2). Among patients who received sumatriptan, frequency and intensity of use differed only minimally between SHI and PHI patients.
  
  
  CONCLUSIONS
  These findings have implications for healthcare researchers and healthcare policies. The framework extends traditional hurdle models and can serve as a model for quantifying barriers to receipt of services under different funding policies.
authors.affiliation: Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kkrobot@web.de
authors.forename: Karl J
authors.initials: KJ
authors.lastname: Krobot
authors.forename: Jay S
authors.initials: JS
authors.lastname: Kaufman
authors.forename: Dale B
authors.initials: DB
authors.lastname: Christensen
authors.forename: John S
authors.initials: JS
authors.lastname: Preisser
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
authors.forename: Michel A
authors.initials: MA
authors.lastname: Ibrahim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003657:Decision Making; D005260:Female; D005858:Germany; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy; D008962:Models, Theoretical; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care; D018170:Sumatriptan / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D018170:Sumatriptan