Cream Skimming by Health Care Providers and Inequality in Health Care Access: Evidence from a Randomized Field Experiment
Refereed Journal // 2021Using 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.