title: Willingness to pay for health insurance among the elderly population in Germany.
abstract: BACKGROUND
  All elderly Germans are legally obliged to have health insurance. About 90 % of this population are members of social health insurances (SHI) whose premiums are generally income-related and independent of health status. For most of these members, holding social health insurance is mandatory. As a consequence, genuine information about preferences for health insurance is not available. The aim of this study was therefore to determine and analyze the willingness to pay (WTP) for health insurance among elderly Germans.
  
  
  METHODS
  Data from a population-based 8-year follow-up of a large cohort study conducted in the Saarland, Germany was used. Participants aged 57-84 years passed a geriatric assessment and responded to a health economic questionnaire. Individuals' WTP was elicited based on a contingent valuation method with a payment card.
  
  
  RESULTS
  Mean monthly WTP per capita for health insurance amounted to €260. This corresponded to about 20% of individual disposable income. Regression analyses showed that WTP increased significantly with higher income, male gender, higher educational level, and privately insured status. In contrast, neither increasing morbidity level nor higher individual health care costs influenced WTP significantly.
  
  
  CONCLUSIONS
  The relatively large extent of average WTP for health insurance indicates that the elderly would probably accept higher contributions to SHI rather than policy efforts to reduce contributions. The identified determinants of WTP might indicate that elderly generally approve the principle of solidarity of the SHI with contributions depending on income rather than morbidity.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. j.bock@uke.de.
authors.forename: Jens-Oliver
authors.initials: JO
authors.lastname: Bock
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Dirk
authors.initials: D
authors.lastname: Heider
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.|Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Philipp-Rosenthal-Straβe 55, 04103, Leipzig, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Matschinger
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.|Network Aging Research, University of Heidelberg, Bergheimer Straße 20, 69115, Heidelberg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Brenner
authors.affiliation: Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120, Heidelberg, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Saum
authors.affiliation: Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Haefeli
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D005858:Germany; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors
keywords: Contingent valuation method; Elderly; Health insurance; WTP