Huber J, Mielck A
Institut für Gesundheitsökonomie und Management im Gesundheitswesen, Helmholtz Zentrum München, Postfach 1129, 85758 Neuherberg.
Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2010 Sep;53(9):925-38. doi: 10.1007/s00103-010-1119-7.
It has rarely been analyzed whether there are differences in Germany concerning morbidity and healthcare between insured by statutory health insurance (Gesetzliche Krankenversicherung, GKV) and insured by private health insurance (Private Krankenversicherung, PKV). In addition, the available studies are very scattered and no review has been published yet. The study presented here aims at closing this gap and at discussing recommendations for future analyses.
By searching for publications in the Medline and PubMed databanks, only a very few studies could be identified in this manner Thus, our search was extended to include a number of German institutes and organizations working in the field of public health and health systems research. In addition, we checked all references listed in the relevant publications.
A total of 18 relevant publications could be identified; however, just four of them were found via Medline and PubMed. The empirical analyses show that the GKV insured are often less healthy than the PKV insured, and that they more often go to primary care physicians. A potential disadvantage of GKV insured concerning healthcare can be seen in regard to new, innovative drugs, organ transplantations, financial burden due to co-payments, waiting times, and communication between patient and physician.
Most studies show that there are large differences between GKV-insured and PKV-insured, concerning health status as well as healthcare. However, due to methodological weaknesses, some of these results are difficult to interpret. More studies focusing on specific age groups (e.g., children) are needed, and the methodological standard (e.g., statistical control for other factors such as income, distinction between different subgroups of insured) must also be raised. Finally, systematic differences between GKV and PKV should be considered in all analyses comparing these two schemes, such as differences in the availability of data concerning healthcare.
在德国，法定医疗保险（Gesetzliche Krankenversicherung，GKV）参保者和私人医疗保险（Private Krankenversicherung，PKV）参保者在发病率和医疗保健方面是否存在差异，这一问题鲜少得到分析。此外，现有研究非常分散，尚未发表过综述。本文所呈现的研究旨在填补这一空白，并讨论未来分析的建议。
通过在Medline和PubMed数据库中搜索出版物，以这种方式仅能识别出极少数研究。因此，我们将搜索范围扩大到包括一些在公共卫生和卫生系统研究领域工作的德国机构和组织。此外，我们检查了相关出版物中列出的所有参考文献。
总共识别出18篇相关出版物；然而，其中只有4篇是通过Medline和PubMed找到的。实证分析表明，GKV参保者的健康状况通常不如PKV参保者，而且他们更常去看初级保健医生。在新型创新药物、器官移植、自付费用导致的经济负担、等待时间以及患者与医生之间的沟通方面，可以看出GKV参保者在医疗保健方面存在潜在劣势。
大多数研究表明，GKV参保者和PKV参保者在健康状况以及医疗保健方面存在很大差异。然而，由于方法上的缺陷，其中一些结果难以解释。需要更多关注特定年龄组（如儿童）的研究，并且还必须提高方法标准（如对收入等其他因素进行统计控制、区分不同参保子群体）。最后，在所有比较这两种保险计划的分析中，都应考虑GKV和PKV之间的系统性差异，例如医疗保健数据可用性方面的差异。
