Effects of the introduction of the German  "Praxisgebühr" on outpatient care and treatment of  patients with atopic eczema.
BACKGROUND
The introduction of a co-payment of 10 Euros per quarter and physician for adults (the so called "Praxisgebühr") as of January 01, 2004 was a significant health policy measure with unknown effects on medical care of patients with atopic eczema (AE).


METHODS
Analysis of an administrative healthcare database from Saxony, Germany. Comparison of outpatient care and treatment of 11,036 patients with AE (6,696 adults) in the year before (2003) and after (2004) the introduction of the co-payment using descriptive statistics and logistic regression modeling.


RESULTS
The proportion of adults with AE treated by dermatologists decreased from 52.8 % in 2003 to 42.3 % in the year after the co-payment was introduced. Consultations of general practitioners by adults and health services utilization by children/adolescents did not change. Treatment with topical calcineurin inhibitors in 2003 was an independent predictor for re-consultation in 2004 (p < 0.001). The proportion of adults receiving systemic steroids for AE significantly increased in 2004 (males: 2003: 5.9 %, 2004: 10.3 %, p < 0.001; females: 2003: 5.7 %, 2004: 8.2 %, p < 0.001). The risk for treatment with systemic steroids increased with the decrease in consulting frequency due to AE relative to 2003 (p = 0.006).


CONCLUSIONS
After the introduction of the German "Praxisgebühr" fewer patients with AE received dermatological treatment. Simultaneously, an unexpectedly significant increase in the (non evidence-based) treatment of AE with systemic steroids was observed, of which patients with relatively lower consultation frequency after the introduction of the co-payment were particularly affected.
Schmitt
Jochen
J
Department of Dermatology, Medical Faculty Carl Gustav Carus, Technical University of Dresden, Germany. jochen.schmitt@uniklinikumdresden.de
Kirch
Wilhelm
W
Meurer
Michael
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000191:economics* / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D017047:Cost Sharing / Q000191:economics* / Q000706:statistics & numerical data; D003876:Dermatitis, Atopic / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D003880:Dermatology / Q000191:economics* / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D055815:Young Adult