Introduction
Background
Regulation of OOPP in Germany
Resource | Regulation of OOPP |
---|---|
Inpatient care | 10 Euro per day for not more than 28 days in hospitals and follow-up-rehabilitations. |
Outpatient services | Physicians: 10 Euro per quarter for the first contact with a general practitioner or specialist; Dentists: 10 Euro per quarter for the first contact; Non-Physicians: 10 Euro per prescription and 10% of costs. |
Medical supplies | Permanent use: 10% of costs but not more than 10 Euro per month; single use: 10% of costs not less than 5 Euro and not more than 10 Euro; glasses are not reimbursed. |
Pharmaceuticals | 10% of costs but not less than 5 Euro and not more than 10 Euro per drug; non-prescription drugs are not reimbursed. |
Dental prostheses | SHI reimburses 50% of costs, in case of regularly check-ups in the last 5 (10) years 70% (80%). |
Nursing care | 10 Euro per prescription plus 10 Euro per day for the first 28 days. |
Aim
Methods
Sample
Out-of-pocket payments
Income and burden
Illness level
Socio-demographic variables
Statistical analyses
Missing values
Results
Socio-demographic and morbidity data
All | Missings | ||
---|---|---|---|
Characteristics | n = 3,124 | (%) | |
Gender: n (%) | 3,124 | (100) | 0 |
- Male | 1,481 | (47.41) | |
- Female | 1,643 | (52.59) | |
Age: mean (SD) | 69.63 | (6.30) | 0 |
Range | 57 - 84 | ||
Marital status: n (%) | 3,087 | (100) | 1.2 |
- Single | 105 | (3.40) | |
- Married | 2,217 | (71.82) | |
- Divorced | 229 | (7.42) | |
- Widowed | 536 | (17.36) | |
Education: n (%) | 3,079 | (100) | 1.4 |
- Under 10 years | 2,038 | (66.19) | |
- 10–11 years | 550 | (17.86) | |
- More than 11 years | 491 | (15.95) | |
3-month net incomea : mean (SD) | 4,299.13 | (2,053.88) | 13.1 |
Health insurance: n (%) | 3,100 | (100) | 0.8 |
- Statutory | 2,859 | (92,23) | |
- Private | 241 | (7.77) | |
CIRS-Gb : mean (SD) | 6.88 | (5.44) | 16.8 |
Analyses of OOPP
Resource | All n = 3,124 | Male n =1,481 | Female n =1,643 | p-valuea |
---|---|---|---|---|
Inpatient care | 5.60 | 5.33 | 5.84 | 0.762 |
(47.53) | (34.08) | (57.01) | ||
Outpatient physician and | 19.95 | 17.96 | 22.54 | 0.031 |
Non-physician services | (70.47) | (71.57) | (69.39) | |
Medical supplies | 40.69 | 40.42 | 40.94 | 0.949 |
(224.58) | (239.12) | (210.70) | ||
Pharmaceuticals | 25.61 | 25.77 | 25.43 | 0.858 |
(52.92) | (47.13) | (58.69) | ||
Dental prostheses | 26.57 | 25.06 | 27.94 | 0.769 |
(274.09) | (312.06) | (234.76) | ||
Nursing care | 1.01 | 1.01 | 1.00 | 0.991 |
(20.10) | (19.63) | (20.50) | ||
Total OOPP | 119.14 | 114.32 | 124.03 | 0.477 |
(381.10) | (420.53) | (341.75) |
Total | Inpatient | Outpatient | |||||||
---|---|---|---|---|---|---|---|---|---|
Independent variables | Logit OR (SE) | GLM b (SE) | Predict. margin | Logit OR (SE) | GLM b (SE) | Predict. margin | Logit OR (SE) | GLM b (SE) | Predict. margin |
Male gender | 0.92 | -0.07 | -10.37 | 1.28 | -0.05 | 1.06 | 0.89 | -0.31** | -7.23** |
(Ref.: Female) | (0.09) | (0.11) | (13.27) | (0.23) | (0.17) | (1.37) | (0.07) | (0.12) | (2.51) |
Private health insurance | 0,29*** | 0.40 | 4.22 | 1.05 | -0.42 | -1,76 | 0.18 | 0.56 | -7-74* |
(Ref.: Statutory)
| (0.05) | (0.23) | (28.53) | (0.35) | (0.30) | (1.80) | (0.03) | (0.32) | (4.38) |
Age | 1.00 | 0.01 | 1.29 | 0.99 | 0.02 | 0.07 | 0.98*** | -0.01 | -0.34 |
(0.01) | (0.01) | (1.04) | (0.01) | (0.01) | (0.11) | (0.01) | (0.01) | (0.20) | |
Education (Ref.: < 10 y.) | |||||||||
- 10–11 years | 1.33* | 0.09 | 17.35 | 0.87* | 0.76*** | 4.23 | 1.15 | 0.19 | 5.16 |
(0.17) | (0.14) | (17.87) | (0.21) | (0.23) | (2.64) | (0.12) | (0.15) | (3.38) | |
- > 11 years | 1.18 | -0.00 | 3.92 | 0.61 | 0.43 | -0.19 | 1.15 | 0.30 | 7.98 |
(0.17) | (0.16) | (18.79) | (0.18) | (0.28) | (1.80) | (0.14) | (0.17) | (4.21) | |
Illness level – CIRS-Gc | 1.00 | 0.03* | 3.12* | 1.03* | 0.01 | 0.26 | 0.99 | 0.01 | 0.03 |
(0.01) | (0.01) | (1.27) | (0.02) | (0.02) | (0.13) | (0.01) | (0.01) | (0.23) | |
Marital status (Ref: married) | |||||||||
- Single | 0.81 | 0.40 | 46.24 | 2.06 | -0.18 | 2.82 | 0.94 | -0.70* | -10.75* |
(0.19) | (0.31) | (45.87) | (0.76) | (0.35) | (3.34) | (0.19) | (0.31) | (3.43) | |
- Divorced | 0.87 | 0.08 | 5.72 | 0.98 | 0.06 | 0.19 | 0.86 | -0.16 | -4.31 |
(0.15) | (0.21) | (23.56) | (0.36) | (0.33) | (2.18) | (0.13) | (0.22) | (3.86) | |
- Widowed | 1.08 | 0.25 | 33.62 | 1.54 | 0.48* | 6.24* | 1.01 | 0.06 | 1.48 |
(0.15) | (0.15) | (20.78) | (0.36) | (0.22) | (2.87) | (0.11) | (0.16) | (3.66) | |
Incomed | 1.03 | 0.09** | 11.15** | 1.09 | -0.04 | 0.25 | 1.07** | 0.12*** | 3.11*** |
(0.03) | (0.03) | (3.80) | (0.05) | (0.05) | (0.36) | (0.02) | (0.03) | (0.73) | |
Constant | 3.55*** | 2.84** | 3.47*** | ||||||
(0.62) | (0.95) | (0.68) | |||||||
N | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 |
Medical supplies
|
Dental prostheses
|
Pharmaceuticals
| |||||||
Independent variables
|
Logit OR (SE)
|
GLM b (SE)
|
Predict. margin
|
Logit OR (SE)
|
GLM b (SE)
|
Predict. margin
|
Logit OR (SE)
|
GLM b (SE)
|
Predict. margin
|
Male gender | 0.87 | 0.22 | 4.14 | 0.93 | -0.28 | -9.06 | 0.99 | -0.09 | -2.84 |
(Ref.: Female)
| (0.09) | (0.21) | (9.08) | (0.19) | (0.26) | (8.65) | (0.08) | (0.07) | (2.41) |
Private health insurance | 0.63* | 0.11 | -9.62 | 0.29* | 2.12** | 35.64 | 0.52*** | 0.62*** | 11.84 |
(Ref.: Statutory)
| (0.14) | (0.42) | (14.51) | (0.18) | (0.79) | (58.06) | (0.08) | (0.15) | (8.96) |
Age | 1.01 | -0.00 | 0.19 | 1.03 | -0.01 | 0.32 | 1.00 | 0.02*** | 0.59* |
(0.01) | (0.02) | (0.69) | (0.02) | (0.02) | (0.65) | (0.01) | (0.01) | (0.19) | |
Education (Ref.: < 10 y.) | |||||||||
- 10–11 years | 1.01 | -0.13 | -4.84 | 1.17 | 0.16 | 9.85 | 1.08 | -0.03 | 0.64 |
(0.13) | (0.25) | (10.20) | (0.28) | (0.32) | (13.47) | (0.11) | (0.09) | (3.20) | |
- > 11 years | 0.87 | -0.06 | -6.79 | 0.78 | -0.21 | -9.64 | 1.07 | 0.04 | 0.83 |
(0.13) | (0.30) | (11.78) | (0.25) | (0.40) | (10.31) | (0.13) | (0.10) | (3.47) | |
Illness level – CIRS-Gc | 1.01 | -0.02 | -0.43 | 1.00 | 0.05* | 1.33 | 1.02 | 0.03*** | 0.98* |
(0.01) | (0.02) | (0.83) | (0.02) | (0.02) | (0.83) | (0.01) | (0.01) | (0.24) | |
Marital status (Ref: married) | |||||||||
- Single | 0.97 | 0.37 | 18.52 | 1.08 | 1.04 | 46.84 | 0.78 | 0.13 | 4.07 |
(0.27) | (0.66) | (30.21) | (0.57) | (0.67) | (57.3) | (0.16) | (0.19) | (9.05) | |
- Divorced | 1.15 | -0.08 | 2.27 | 1.43 | -0.11 | 5.94 | 0.88 | 0.14 | 2.68 |
(0.21) | (0.42) | (13.87) | (0.49) | (0.46) | (15.72) | (0.13) | (0.13) | (4.71) | |
- Widowed | 1.49** | 0.34 | 32.23 | 1.25 | 0.06 | 7.10 | 1.16 | -0.03 | 1.11 |
(0.19) | (0.30) | (17.02) | (0.31) | (0.32) | (11.36) | (0.13) | (0.09) | (3.21) | |
Incomed | 1.02 | 0.07 | 3.69 | 1.06 | 0.08 | 3.60 | 1.02 | 0.05** | 1.74* |
(0.03) | (0.06) | (2.43) | (0.06) | (0.08) | (2.66) | (0.02) | (0.02) | (0.69) | |
Constant | 5.17*** | 6.48*** | 1.51*** | ||||||
(1.21) | (1.31) | (0.39) | |||||||
N | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 | 3,122 |
Analyses of financial burden due to OOPP
Independent predictor variables | Odds ratio | 95% CI | |
---|---|---|---|
Male gender (reference: female) | 0.880 | (0.708 | 1.093) |
Private health insurance (reference: SHI) | 0.890 | (0.564 | 1.405) |
Age | 1.017* | (1.001 | 1.034) |
Education 10–11 years (reference: <10 years) | 1.090 | (0.842 | 1.410) |
>11 years | 0.929 | (0.693 | 1.245) |
Illness level – CIRS-Gb | 1.020 | (0.998 | 1.042) |
Marital status: Single (reference: married) | 1.619 | (0.812 | 3.231) |
Divorced | 1.081 | (0.746 | 1.565) |
Widowed | 1.418* | (1.070 | 1.880) |
Income quintile 2 (reference: quintile 1) | 0.708 | (0.478 | 1.047) |
Income quintile 3 | 0.737 | (0.520 | 1.044) |
Income quintile 4 | 0.715 | (0.503 | 1.016) |
Income quintile 5 | 0.478** | (0.311 | 0.733) |
N | 3,124 |