Long waiting times are a common feature and a major concern in many public health care systems. They are often characterized as inefficient because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the preferential treatment given to private health insurance (PHI) holders while statutory health insurance (SHI) holders face continuously increasing waiting times. In order to tackle this problem in the outpatient sector, Germany initiated a reform in 2015 which was aimed at providing SHI holders with appointments within an acceptable time frame. We exploit longitudinal experimental data to examine waiting times for six elective outpatient treatments in Germany for PHI and SHI holders before and after the reform. We find a considerable difference in waiting times favoring private patients. For SHI holders, waiting times remained stable over time (27.5 days in 2014, 30.7 days in 2016, Δ 3.2 days, p-value=0.889) while PHI holders experienced a significant improvement (13.5 days in 2014; 7.8 days in 2016; Δ 5.7 days, p-value=0.002). The results indicate that even after the reform there is still an unequal access to elective outpatient treatment depending on the patient’s insurance status.
Ai, C., E.C. Norton. (2003), Interaction Terms in Logit and Probit Models, Economics Letters 80 (1): 123–129.
Asplin, B.R., K.V. Rhodes, H. Levy, N. Lurie, A.L. Crain, B.P. Carlin, A.L. Kellermann. (2005), Insurance Status and Access to Urgent Ambulatory Care Follow-Up Appointments, Journal of the American Medical Association 294 (10): 1248–1254.
Bundestag, D. (2015), Gesetz Zur Stärkung Der Versorgung in Der Gesetzlichen Krankenversicherung, Bundesgesetzblatt 2015 (30): 1211–1244.
Cullis, J.G., P.R. Jones, C. Propper. (2000), Waiting Lists and Medical Treatment: Analysis and Policies. Handbook of Health Economics 1 (PART B): 1201–1249.
Finkenstädt, V., F. Niehaus. (2013), Rationierung Und Versorgungsunterschiede in Gesundheitssystemen: Ein Internationaler Überblick. WIP, Wissenschaftliches Institut der PKV.
Johannesson, M., P.-O. Johansson, T. Söderqvist. (1998), Time Spent on Waiting Lists for Medical Care: An Insurance Approach. Journal of Health Economics 17: 627–644.
Lindsay, C.M., B. Feigenbaum. (1984), Rationing by Waiting Lists on JSTOR, The American Economic Review 74 (3): 404–417.
Lungen, M., B. Stollenwerk, P. Messner, K.W. Lauterbach, A. Gerber. (2008), Waiting Times for Elective Treatments according to Insurance Type: A Randomized Empirical Study in Germany. International Journal for Equity in Health 7: 1.
Niehaus, F. (2009), Ein Vergleich Der Ärztlichen Vergütung Nach GOÄ Und EBM. WIP-Diskussionspapier 7: 09.
Roll, K., T. Stargardt, J. Schreyögg. (2012), Effect of Type of Insurance and Income on Waiting Time for Outpatient Care, The Geneva Papers on Risk and Insurance Issues and Practice 37 (S4): 609–632.
Salm, M., A. Wübker, (2017). Causes of Regional Variation in Healthcare Utilization in Germany. Ruhr Economic Papers 675.
Sauerland, D., B.A. Kuchinke, A. Wübker. (2009), Warten Gesetzlich Versicherte Länger? Zum Einfluss Des Versichertenstatus Auf Den Zugang Zu Medizinischen Leistungen Im Stationären Sektor, Gesundheitsökonomie & Qualitätsmanagement 14 (02): 86–94.
Schwierz, C., A. Wübker, A. Wübker, B.A. Kuchinke. (2011), Discrimination in Waiting Times by Insurance Type and Financial Soundness of German Acute Care Hospitals, European Journal of Health Economics 12 (5): 405–416.
Siciliani, L., J. Hurst. (2005), Tackling Excessive Waiting Times for Elective Surgery: A Comparative Analysis of Policies in 12 OECD Countries, Health Policy 72 (2): 201–215.
Siciliani, L., V. Moran, M. Borowitz. (2014), Measuring and Comparing Health Care Waiting Times in OECD Countries, Health Policy 118 (3): 292–303.
Siciliani, L., R. Verzulli. (2009), Waiting Times and Socioeconomic Status among Elderly Europeans: Evidence from Share, Health Economics 18 (11): 1295–1306.
Sundmacher, L., T. Kopetsch. (2013), Waiting Times in the Ambulatory Sector–The Case of Chronically Ill Patients, International Journal for Equity in Health 12 (1): 77.
Viberg, N., B.C. Forsberg, M. Borowitz, R. Molin. (2013), International Comparisons of Waiting Times in Health Care – Limitations and Prospects, Health Policy 112 (1–2): 53–61.
Journal of Economics and Statistics is a scientific journal published in Germany since 1863. The Journal publishes papers in all fields of economics and applied statistics. A specific focus is on papers combining theory with empirical analyses.