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Do Patients with Compulsory Health Insurance have to Wait Longer? The Influence of the Insurance Status on the Access to Medical Services in the In-Patient Care Sector in Germany

Background: International studies (e.g. Asplin et al. 2005) show that waiting time for inpatient treatment depends on how the claimed services are financed. In Germany there is an ongoing debate about the assumption that privately insured patients do not only receive more benefits than members of the statutory health insurance but that they also have better access to diagnosis and treatment services. This assumption is also supported by a current study (WIdO 2006) for the German outpatient sector. Problem: Existing analysis of the determinants for waiting times in Germany are essentially based on the questioning of patients and do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals. Methods: We selected 3 diagnoses for medical problems, where treatment has to be started at short notice. The diagnoses were taken from gynecology (cervical conization for PAP III D), cardiology (stenosis) and surgery (Weber B fracture). For these diagnoses, anonymous telephone calls were performed to make an appointment for inpatient treatment. Altogether, 687 hospitals were included in the study. The interviewers recorded, (i) whether or not the hospitals asked actively if the caller was privately insured and (ii) the time between the call and the appointed date for treatment. The data was then analyzed econometrically to find out if the kind of insurance had an impact on the waiting time. Methods applied were T-Test for paired samples and Mcnemars test respectively. Results: The results show that 25 percent of the hospitals actively ask for the kind of insurance coverage, that patients have. Within this group of hospitals, the average waiting time for a treatment appointment is significantly longer for members of the statutory health insurance funds. Whereas 41 percent of privately insured patients received a date for treatment within one week after the appointment call, only 28 percent of the statutory health insured patients got a date in that period of time. On average, they have to wait 1,6 days longer for an treatment than those privately insured. Conclusion: The results introduced here may be of interest for political decision makers. This not only applies before the background of basic discussions repeatedly held in Germany with regard to a two-class medical system, which also include the access to medical services.