Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment

Anna Werbeck, Ansgar Wübker and Nicolas Ziebarth ()

Journal of Economic Behavior & Organization, 2021, vol. 188, issue C, 1325-1350

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: Health care inequality; Inequity; Reimbursement rates; Health care access; Discrimination; Cherry picking; Gastroscopy; Audiometry; Allergy test; Allergists; Otorhinolaryngologist; Gastroenterologist (search for similar items in EconPapers)
JEL-codes: I11 I14 I18 (search for similar items in EconPapers)
Date: 2021
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (8)

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Related works:
Working Paper: Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment (2021)
Working Paper: Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment (2020)
Working Paper: Cream skimming by health care providers and inequality in health care access: Evidence from a randomized field experiment (2020)
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Persistent link: https://EconPapers.repec.org/RePEc:eee:jeborg:v:188:y:2021:i:c:p:1325-1350

DOI: 10.1016/j.jebo.2021.05.028

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