Max Planck Society, Munich Center for the Economics of Aging, Munich, Germany.
Health Econ. 2013 Sep;22(9):1111-23. doi: 10.1002/hec.2955. Epub 2013 Jun 17.
When health insurance reforms involve non-linear price schedules tied to payment periods (for example, fees levied by quarter or year), the empirical analysis of its effects has to take the within-period time structure of incentives into account. The analysis is further complicated when demand data are obtained from a survey in which the reporting period does not coincide with the payment period. We illustrate these issues using as an example a health care reform in Germany that imposed a per-quarter fee of €10 for doctor visits and additionally set an out-of-pocket maximum. This co-payment structure results in an effective 'spot' price for a doctor visit that decreases over time within each payment period. Taking this variation into account, we find a substantial reform effect-especially so for young adults. Overall, the number of doctor visits decreased by around 9% in the young population. The probability of visiting a physician in any given quarter decreased by around 4 to 8 percentage points.
当医疗保险改革涉及与支付期（例如按季度或年度征收的费用）相关的非线性价格表时，其效果的实证分析必须考虑到激励措施的期间内时间结构。当需求数据来自调查中且报告期与支付期不一致时，分析会更加复杂。我们使用德国的一项医疗改革为例来说明这些问题，该改革对每次就诊收取 10 欧元的季度费用，并另外设定了自付额上限。这种共付结构导致每次就诊的有效“实时”价格随着支付期内的时间而降低。考虑到这种变化，我们发现了相当大的改革效果——尤其是对年轻人来说。总体而言，年轻人群体中就诊次数减少了约 9%。在任何给定季度就诊的概率下降了约 4 至 8 个百分点。
