A Longitudinal Investigation of Willingness to Pay for Health Insurance in Germany.
To investigate factors affecting willingness to pay (WTP) for health insurance of older adults in a longitudinal setting in Germany.



Survey data from a cohort study in Saarland, Germany, from 2008-2010 and 2011-2014 (n1= 3,124; n2= 2,761) were used.



Panel data were taken at two points from an observational, prospective cohort study.



WTP estimates were derived using a contingent valuation method with a payment card. Participants provided data on sociodemographics, lifestyle factors, morbidity, and health care utilization.



Fixed effects regression models showed higher individual health care costs to increase WTP, which in particular could be found for members of private health insurance. Changes in income and morbidity did not affect WTP among members of social health insurance, whereas these predictors affected WTP among members of private health insurance.



The fact that individual health care costs affected WTP positively might indicate that demanding (expensive) health care services raises the awareness of the benefits of health insurance. Thus, measures to increase WTP in old age should target at improving transparency of the value of health insurances at the moment when individual health care utilization and corresponding costs are still relatively low.
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Jens-Oliver
JO
Bock
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
André
A
Hajek
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.|Network Aging Research, University of Heidelberg, Heidelberg, Germany.
Hermann
H
Brenner
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Kai-Uwe
KU
Saum
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.|Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
Herbert
H
Matschinger
Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
Walter Emil
WE
Haefeli
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Ben
B
Schöttker
Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany.
Renate
R
Quinzler
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Dirk
D
Heider
Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Hans-Helmut
HH
König
D000368:Aged; D005260:Female; D005382:Financing, Personal / Q000191:economics / Q000706:statistics & numerical data*; D005858:Germany; D005102:Health Expenditures; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D011795:Surveys and Questionnaires
Germany; Health insurance; contingent valuation method; older adults; willingness to pay