The "cost reimbursement" trial regulation in mandatory health insurance: results of a survey of participants

Since 1994 seven substitution funds of the German statutory health insurance have offered their mandatorily insured members to choose cost reimbursement in place of benefits in kind for a limited testing period. Participants of the cost reimbursement arrangement are considered private patients and are billed accordingly. However, these bills are only in part reimbursed. This study investigates the expectations participants had with respect to the cost reimbursement arrangement as well as the experiences they made. For this purpose a survey among the participants was carried out using a self-administered questionnaire. Most of the 1390 respondents were satisfied with the cost reimbursement arrangement. Organisational, personal and medical advantages which the majority of participants expected were mostly fulfilled. Especially elderly members chose the cost reimbursement arrangement and often made the experience that their doctors spent more time talking to them. The necessary co-payments had hardly any impact on the positive judgment; most participants had an extra private insurance to close the gap of coverage. The results also show that transparency, control of costs and cost-consciousness of patients are improved by the cost reimbursement method. With respect to the preferences of the insured, the results of this study plead for keeping up the offer of cost reimbursement as an alternative to benefits in kind. However, the influence of sickness funds on the care process as well as the equity of care may be negatively affected.