Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment

56 Pages Posted: 6 Apr 2020

See all articles by Anna Werbeck

Anna Werbeck

affiliation not provided to SSRN

Ansgar Wübker

RWI

Nicolas R. Ziebarth

Cornell University

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 more than twice as high 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 7% 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. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.

Keywords: health care inequality, reimbursement rates, health care access, discrimination, cherry picking, gastroscopy, audiometry, allergy test, allergists, otorhinolaryngologist, gastroenterologist

JEL Classification: I14, I11, I18

Suggested Citation

Werbeck, Anna and Wübker, Ansgar and Ziebarth, Nicolas R., Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment. IZA Discussion Paper No. 13100, Available at SSRN: https://ssrn.com/abstract=3568305

Anna Werbeck (Contact Author)

affiliation not provided to SSRN

No Address Available

Ansgar Wübker

RWI ( email )

Hohenzollernstr. 1-3
Essen, 45128
Germany

Nicolas R. Ziebarth

Cornell University ( email )

Ithaca, NY
United States

HOME PAGE: http://www.human.cornell.edu/bio.cfm?netid=nrz2

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