Abstract
BackgroundIn 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented in the German health care system, mainly in order to reduce expenditures of sickness funds by reducing outpatient physician visits. In the statutory sickness funds, all adults now have to pay € 10 at their first physician visit in each 3 month period, except for vaccinations and preventive services. This study looks at the effect of this new patient fee on delaying or avoiding physician visits, with a special emphasis on different income groups.MethodsSix representative surveys (conducted between 2004 and 2006) of the Bertelsmann Healthcare Monitor were analysed, comprising 7,769 women and men aged 18 to 79 years. The analyses are based on stratified analyses and logistic regression models, including a focus on the subgroup having a chronic disease.ResultsTwo results can be highlighted. First, avoiding or delaying a physician visit due to this fee is seen most often among younger and healthier adults. Second, those in the lowest income group are much more affected in this way than the better of. The multivariate analysis in the subgroup of respondents having a chronic disease shows, for example, that this reaction is reported 2.45 times more often in the lowest income group than in the highest income group (95% CI: 1.90–3.15).ConclusionThe analyses indicate that the effects of the practice charge differ by socio-economic group. It would be important to assess these effects in more detail, especially the effects on health care quality and health outcomes. It can be assumed, however, that avoiding or delaying physician visits jeopardizes both, and that health inequalities are increasing due to the practice charge.
Highlights
In 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented in the German health care system, mainly in order to reduce expenditures of sickness funds by reducing outpatient physician visits
The analyses indicate that the effects of the practice charge differ by socio-economic group
BMC Health Services Research 2008, 8:232 http://www.biomedcentral.com/1472-6963/8/232 practice charge ('Praxisgebuehr') of 10 for the first contact at a physician's or dentist's office in each 3 month period was introduced as part of the 'Statutory Health Insurance Modernization Law' (§28, clause 4, SGB V)
Summary
In 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented in the German health care system, mainly in order to reduce expenditures of sickness funds by reducing outpatient physician visits. This study looks at the effect of this new patient fee on delaying or avoiding physician visits, with a special emphasis on different income groups. The practice fee is not charged for preventive medical services, such as cancer screenings, examinations to ensure a normal pregnancy, general health checks (for people above 35 years of age) and dental prophylaxis. It is paid in cash at the doctor's office, sent to the statutory health insurance (i.e. the physician has to ask the patient for this money, but cannot keep it). People with a lower socio-economic status are more affected and clearly tend to avoid or delay physician visits because of the fee
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