# Insurance barriers and inequalities in health care access: evidence from dual practice

## TL;DR

This study finds that private health insurance in Germany leads to better access to less complex diabetes treatments compared to public insurance, with practice composition affecting treatment disparities.

## Contribution

The study reveals how insurance type and physician practice composition influence access to antidiabetic care in Germany.

## Key findings

- Private insurance patients are 10 percentage points more likely to receive less complex treatments than public insurance patients.
- Physician practice composition significantly affects treatment access disparities.
- The largest disparities are observed in practices with average regional composition.

## Abstract

We investigate access disparities in pharmaceutical care among German patients with type 2 diabetes, focusing on differences between public and private health insurance schemes. The primary objectives include investigating whether patients with private health insurance experience enhanced access to antidiabetic care and analyzing whether the treatment received by public and private patients is influenced by the practice composition, particularly the proportion of private patients.

We estimate fixed effect regression models, to isolate the effect of insurance schemes on treatment choices. We utilize data from a prescriber panel comprising 681 physicians collectively serving 68,362 patients undergoing antidiabetic treatments.

The analysis reveals a significant effect of the patient's insurance status on antidiabetic care access. Patients covered by private insurance show a 10-percentage-point higher likelihood of receiving less complex treatments compared to those with public insurance. Furthermore, the composition of physicians' practices plays a crucial role in determining the likelihood of patients receiving less complex treatments. Notably, the most pronounced disparities in access are observed in practices mirroring the regional average composition.

Our findings underscore strategic physician navigation across diverse health insurance schemes in ambulatory care settings, impacting patient access to innovative treatments.

The online version contains supplementary material available at 10.1186/s13561-024-00500-y.