Krauth C, Schwartz F W
Abteilung Epidemiologie und Sozialmedizin, Medizinische Hochschule Hannover.
Med Klin (Munich). 1998 Jan 15;93(1):49-51. doi: 10.1007/BF03045042.
Benefits-in-kind and co-payment are often regarded as instruments to support self-responsible demand of the insured and to generate effective cost control. Economic theory however assumes that benefits-in-kind alone (without co-payment) will not have a great influence on the demand decision of the insured, because with rational behaviour price is not a determinant of demand. Also the control effects of (limited) co-payment are to be regarded as rather low. According to the hypothesis of supplier induced demand the major influence on demand is generated by those providing health care services, as soon as the patient has made up the decision to visit a doctor. But co-payment determines the decision and the timing of the initial contact, resulting in potentially negative effects on medical outcome. This is especially true, if co-payment ist not moderated by social policy. These theoretical considerations are supported by empirical evidence provided by the example of the French ambulatory care sector.
实物福利和共付额通常被视为支持被保险人自我负责需求以及实现有效成本控制的手段。然而，经济理论认为，仅实物福利（无共付额）对被保险人的需求决策影响不大，因为在理性行为下价格并非需求的决定因素。而且（有限的）共付额的控制效果也相当低。根据供应商诱导需求假说，一旦患者决定就医，对需求的主要影响就由提供医疗服务的一方产生。但共付额决定了首次接触的决策和时机，可能对医疗结果产生负面影响。如果社会政策不对共付额进行调节，情况尤其如此。法国门诊护理部门的实例所提供的经验证据支持了这些理论考量。
