Abstract

Issues of unequal risk distribution among sickness funds are given increasing attention in the current discussions on the reform of the statutory health insurance system in Germany. This paper raises the question on the structural determinants of risk segregation and points towards the links between social stratification, health risk and insurance status. A model showing the links between basic structural determinants is presented. Using health survey data from Germany and the U.S. statistical analyses are conducted. The results support the model and indicate its applicability for both health care systems. The paper concludes by indicating the relevance of such findings for health policy and future research.

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