Working Paper: NBER ID: w28809
Authors: Anna Werbeck; Ansgar Wübker; Nicolas R. Ziebarth
Abstract: Using a randomized field experiment, we show that health care specialists cream-skim patients by their expected profitability. In the German two-tier system, outpatient reimbursement rates for both public and private insurance are centrally determined but are significantly higher for the privately insured. In our field experiment, following a standardized protocol, the same hypothetical patient called 991 private practices in 36 German counties to schedule appointments for allergy tests, hearing tests and gastroscopies. Practices were 4% more likely to offer an appointment to the privately insured. Conditional on being offered an appointment, wait times for the publicly insured were twice as long than for the privately insured. We also find smaller access differences when reimbursement rate differences are smaller. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.
Keywords: No keywords provided
JEL Codes: I11; I14; I18
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| reimbursement rate differentials (J33) | access discrimination (J71) |
| insurance status (I13) | likelihood of appointment offers (M51) |
| insurance status (I13) | wait times (C41) |