Netspar, CentER, Department of Economics, Tilburg University, Tilburg, The Netherlands.
Health Econ. 2010 Sep;19(9):1048-62. doi: 10.1002/hec.1642.
In Germany, employees are generally obliged to participate in the public health insurance system, where coverage is universal, co-payments and deductibles are moderate, and premia are based on income. However, they may buy private insurance instead if their income exceeds the compulsory insurance threshold. Here, premia are based on age and health, individuals may choose to what extent they are covered, and deductibles and co-payments are common. In this paper, we estimate the effect of private insurance coverage on the number of doctor visits, the number of nights spent in a hospital and self-assessed health. Variation in income around the compulsory insurance threshold provides a natural experiment that we exploit to control for selection into private insurance. We document that income is measured with error and suggest an approach to take this into account. We find negative effects of private insurance coverage on the number of doctor visits, no effects on the number of nights spent in a hospital, and positive effects on health.
在德国，员工通常有义务参加公共医疗保险体系，该体系的覆盖范围是普遍的，共同支付和免赔额适中，保费则根据收入而定。然而，如果他们的收入超过强制保险门槛，他们可以选择购买私人保险。在这种情况下，保费取决于年龄和健康状况，个人可以选择保险的覆盖范围，并且共同支付和免赔额很常见。在本文中，我们估计了私人保险覆盖范围对医生就诊次数、住院夜数和自我评估健康状况的影响。收入在强制保险门槛周围的变化提供了一个自然实验，我们利用这个实验来控制私人保险的选择。我们证明收入是有误差的，并提出了一种考虑这一点的方法。我们发现私人保险覆盖范围对医生就诊次数有负面影响，对住院夜数没有影响，对健康有积极影响。
