Using a randomized field experiment, we show that health care specialists cream-skim pa- tients by their expected profitability. In the German two-tier system, outpatient reimburse- ment rates for both public and private insurance are centrally determined but are signif- icantly higher 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 4% more likely to offer an appointment to the privately insured. Conditional on being of- fered an appointment, wait times for the publicly insured were twice as long than for the privately insured. We also find smaller access differences when reimbursement rate dif- ferences are smaller. Our findings show that structural differences in reimbursement rates lead to structural differences in health care access.
Werbeck, Anna, Ansgar Wübker and Nicolas R. Ziebarth (2021), Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment, Journal of Economic Behavior and Organization 188 , 1325-1350