title: Are German patients burdened by the practice charge for physician visits ('Praxisgebuehr')? A cross sectional analysis of socio-economic and health related factors.
abstract: BACKGROUND
  In 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented in the German health care system, mainly in order to reduce expenditures of sickness funds by reducing outpatient physician visits. In the statutory sickness funds, all adults now have to pay euro 10 at their first physician visit in each 3 month period, except for vaccinations and preventive services. This study looks at the effect of this new patient fee on delaying or avoiding physician visits, with a special emphasis on different income groups.
  
  
  METHODS
  Six representative surveys (conducted between 2004 and 2006) of the Bertelsmann Healthcare Monitor were analysed, comprising 7,769 women and men aged 18 to 79 years. The analyses are based on stratified analyses and logistic regression models, including a focus on the subgroup having a chronic disease.
  
  
  RESULTS
  Two results can be highlighted. First, avoiding or delaying a physician visit due to this fee is seen most often among younger and healthier adults. Second, those in the lowest income group are much more affected in this way than the better of. The multivariate analysis in the subgroup of respondents having a chronic disease shows, for example, that this reaction is reported 2.45 times more often in the lowest income group than in the highest income group (95% CI: 1.90-3.15).
  
  
  CONCLUSIONS
  The analyses indicate that the effects of the practice charge differ by socio-economic group. It would be important to assess these effects in more detail, especially the effects on health care quality and health outcomes. It can be assumed, however, that avoiding or delaying physician visits jeopardizes both, and that health inequalities are increasing due to the practice charge.
authors.affiliation: Helmholtz Zentrum Muenchen - German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany. ina-maria.rueckert@helmholtz-muenchen.de
authors.forename: Ina-Maria
authors.initials: IM
authors.lastname: Rückert
authors.forename: Jan
authors.initials: J
authors.lastname: Böcken
authors.forename: Andreas
authors.initials: A
authors.lastname: Mielck
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D003430:Cross-Sectional Studies; D005249:Fees and Charges; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D009819:Office Visits / Q000191:economics*; D010342:Patient Acceptance of Health Care; D012959:Socioeconomic Factors; D055815:Young Adult