title: Per-period co-payments and the demand for health care: evidence from survey and claims data.
abstract: When health insurance reforms involve non-linear price schedules tied to payment periods (for example, fees levied by quarter or year), the empirical analysis of its effects has to take the within-period time structure of incentives into account. The analysis is further complicated when demand data are obtained from a survey in which the reporting period does not coincide with the payment period. We illustrate these issues using as an example a health care reform in Germany that imposed a per-quarter fee of €10 for doctor visits and additionally set an out-of-pocket maximum. This co-payment structure results in an effective 'spot' price for a doctor visit that decreases over time within each payment period. Taking this variation into account, we find a substantial reform effect-especially so for young adults. Overall, the number of doctor visits decreased by around 9% in the young population. The probability of visiting a physician in any given quarter decreased by around 4 to 8 percentage points.
authors.affiliation: Max Planck Society, Munich Center for the Economics of Aging, Munich, Germany. farbmacher@mea.mpisoc.mpg.de
authors.forename: Helmut
authors.initials: H
authors.lastname: Farbmacher
authors.forename: Joachim
authors.initials: J
authors.lastname: Winter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
keywords: co-payments; health economics; natural experiment; non-linear pricing