Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland

Huber, Carola A.; Rüesch, Peter; Mielck, Andreas; Böcken, Jan; Rosemann, Thomas; Meyer, Peter C.

doi:10.1111/j.1365-2753.2011.01679.x

Publication type:	Article in scientific journal
Type of review:	Peer review (publication)
Title:	Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland
Authors:	Huber, Carola A. Rüesch, Peter Mielck, Andreas Böcken, Jan Rosemann, Thomas Meyer, Peter C.
DOI:	10.1111/j.1365-2753.2011.01679.x
Published in:	Journal of Evaluation in Clinical Practice
Volume(Issue):	18
Issue:	4
Page(s):	781
Pages to:	787
Issue Date:	26-Apr-2011
Publisher / Ed. Institution:	Wiley
ISSN:	1356-1294 1365-2753
Language:	English
Subject (DDC):	360: Social problems and social insurance
Abstract:	Background: Several studies have assessed the effect of cost sharing on health service utilization (HSU), mostly in the USA. Results are heterogeneous, showing different effects. Whereas previous studies compared insurants within one health care system but different modes of insurance, we aimed at comparing two different health care systems in Europe: Germany and Switzerland. Furthermore, we assessed the impact of cost sharing depending on socio-demographic factors as well as health status. Methods: Two representative samples of 5197 Swiss insurants with and 5197 German insurants without cost sharing were used to assess the independent association between cost sharing and the use of outpatient care. To minimize confounding, we performed crosssectional analyses between propensity score matched Swiss and German insurants. We investigated subgroups according to health and socio-economic status to assess a potential social gradient in HSU. Results: We found a significant association between health insurance scheme and the use of outpatient services. German insurants without cost sharing (visit rate: 4.8 per year) consulted a general practitioner or specialist more frequently than Swiss insurants with cost sharing (visit rate: 3.0 per year; P < 0.01). Subgroup analyses showed that vulnerable populations were differently affected by cost sharing. In the group of respondents with poor health and low socio-economic status, the cost-sharing effect was strongest. Conclusion: Cost-sharing models reduce HSU. The challenge is to create cost-sharing models which do not preclude vulnerable populations from seeking essential health care.
URI:	https://digitalcollection.zhaw.ch/handle/11475/3840
Fulltext version:	Published version
License (according to publishing contract):	Licence according to publishing contract
Departement:	School of Health Sciences
Organisational Unit:	Institute of Public Health (IPH)
Appears in collections:	Publikationen Gesundheit

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Huber, C. A., Rüesch, P., Mielck, A., Böcken, J., Rosemann, T., & Meyer, P. C. (2011). Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland. Journal of Evaluation in Clinical Practice, 18(4), 781–787. https://doi.org/10.1111/j.1365-2753.2011.01679.x

Huber, C.A. et al. (2011) ‘Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland’, Journal of Evaluation in Clinical Practice, 18(4), pp. 781–787. Available at: https://doi.org/10.1111/j.1365-2753.2011.01679.x.

C. A. Huber, P. Rüesch, A. Mielck, J. Böcken, T. Rosemann, and P. C. Meyer, “Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland,” Journal of Evaluation in Clinical Practice, vol. 18, no. 4, pp. 781–787, Apr. 2011, doi: 10.1111/j.1365-2753.2011.01679.x.

HUBER, Carola A., Peter RÜESCH, Andreas MIELCK, Jan BÖCKEN, Thomas ROSEMANN und Peter C. MEYER, 2011. Effects of cost sharing on seeking outpatient care : a propensity-matched study in Germany and Switzerland. Journal of Evaluation in Clinical Practice. 26 April 2011. Bd. 18, Nr. 4, S. 781–787. DOI 10.1111/j.1365-2753.2011.01679.x

Huber, Carola A., Peter Rüesch, Andreas Mielck, Jan Böcken, Thomas Rosemann, and Peter C. Meyer. 2011. “Effects of Cost Sharing on Seeking Outpatient Care : A Propensity-Matched Study in Germany and Switzerland.” Journal of Evaluation in Clinical Practice 18 (4): 781–87. https://doi.org/10.1111/j.1365-2753.2011.01679.x.

Huber, Carola A., et al. “Effects of Cost Sharing on Seeking Outpatient Care : A Propensity-Matched Study in Germany and Switzerland.” Journal of Evaluation in Clinical Practice, vol. 18, no. 4, Apr. 2011, pp. 781–87, https://doi.org/10.1111/j.1365-2753.2011.01679.x.