Do Persons that Changed Health Insurance Differ From those Who did not? The Case of Diabetes

Abstract

Aims: We aimed to compare German adults that changed health insurance since 1996 with those who did not with special emphasis on diabetes.

Methods: 8 representative surveys (conducted 2005–2008) of the ‘Bertelsmann Healthcare Monitor’ comprising 12 362 participants aged 18–79 years were analysed. We compared participants that changed their health insurance fund with those who did not. To study if diabetes is associated with switching, we fitted logistic regression models and stepwise adjusted for age, sex, cardiovascular comorbidities, anthropometric measures and health-related factors.

Results: About one third (32.0%) changed their health insurance fund since 1996. Compared to persons that did not change, those who did were younger, higher educated, assessed their health status better and had less cardiovascular diseases. The prevalence of diabetes was much lower in persons that changed their fund than in those who did not (3.6% vs. 8.9%; Odds Ratio [OR]: 0.38; 95% confidence interval [CI]: 0.31–0.47). Adjusting for age and sex leads to a non-significant OR of 0.81 (95% CI: 0.64–1.02), which remained in the fully adjusted model (OR: 0.88; 95% CI: 0.69–1.12).

Conclusions: Persons that changed their fund had a much lower prevalence of diabetes than those who did not. Most of this difference could be explained by age. We found quite similar figures for hypertension, a more prevalent disease. However, ORs were significant in all described models, probably due to a higher statistical power.

Key words

cross-sectional studies - diabetes mellitus - epidemiology - health insurance companies

References

• 1 BMG. . Gesetzliche Krankenversicherung: Mitglieder, mitversicherte Angehörige, Beitragssätze und Krankenstand.  Monatswerte Januar-Dezember 2008 (Ergebnisse der GKV-Statistik KM1), 2009;  http://www.bmg.bund.de/cln_151/nn_1168278/SharedDocs/Downloads/DE/Statistiken/Gesetzliche-Krankenversicherung/Mitglieder-und-Versicherte/KM1-Oktober-08,templateId=raw,property=publicationFile.pdf/KM1-Oktober-08.pdf Accessed: 07 December, 2010. (Archived by WebCite ® at http://www.webcitation.org/5p13WV6qu ).
• 2 Braun B, Greß S, Höppner K. et al .Barrieren für einen Wechsel der Krankenkasse: Loyalität, Bequemlichkeit, Informationsdefizite?. Gütersloh: Verlag Bertelsmann Stiftung; 2006: 11-31
• 3 Geyer S, Peter R, Nielsen I. Health inequalities in different age groups: the case of type 2-diabetes: a study with health insurance and medication data.  Soz Praventivmed. 2004;  49 (5) 328-335
• 4 Güther B. Gesundheitsmonitor-Stichprobe und Erhebungsmethode sowie Qualitätsaspekte der Ergebnisse.. Gütersloh: Verlag Bertelsmann-Stiftung; 2006: 309-322
• 5 Hauner H, Köster I, Schubert I. Trends in der Prävalenz und ambulanten Versorgung von Menschen mit Diabetes mellitus. Eine Analyse der Versichertenstichprobe AOK Hessen/KV Hessen im Zeitraum von 1998 bis 2004.  Dtsch Ärztebl. 2007;  104 (41) A2799-A2805
• 6 Hoffmann F, Haastert B, Koch M. et al . The effect of diabetes on incidence and mortality in end-stage renal disease in Germany.  Nephrol Dial Transplant. 2011;  26 (5) 1634-1640
• 7 Hoffmann F, Icks A. Diabetes prevalence based on health insurance claims: large differences between companies.  Diabet Med. 2011;  Mar 23, [Epub ahead of print]
• 8 Hoffmann F. Review on use of German health insurance medication claims data for epidemiological research.  Pharmacoepidemiol Drug Saf. 2009;  18 (5) 349-356
• 9 Icks A, Haastert B, Trautner C. et al . Incidence of lower-limb amputations in the diabetic compared to the non-diabetic population. Findings from nationwide insurance data, Germany, 2005–2007.  Exp Clin Endocrinol Diabetes. 2009;  117 (9) 500-504
• 10 Icks A, Scheer M, Genz J. et al . Stroke in the diabetic and non-diabetic population in Germany: relative and attributable risks, 2005–2007.  J Diabetes Complications. 2011;  25 (2) 90-96
• 11 Knaus T, Nuscheler R. Incomplete risk adjustment and adverse selection in the German public health insurance system.. WZB Discussion Papers FS IV 02–27. Berlin: WZB; 2002
• 12 Köster I, Huppertz E, Hauner H. et al . Direct Costs of Diabetes Mellitus in Germany – CoDiM 2000-2007.  Exp Clin Endocrinol Diabetes. 2011;  119 (6) 377-385
• 13 Köster I, von Ferber L, Ihle P. et al . The cost burden of diabetes mellitus: the evidence from Germany – the CoDiM Study.  Diabetologia. 2006;  9 (7) 1498-1504
• 14 Lisac M, Reimers L, Henke KD. et al . Access and choice – competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004.  Health Econ Policy Law. 2010;  5 (Pt 1) 31-52
• 15 Rückert IM, Böcken J, Mielck A. Are German patients burdened by the practice charge for physician visits (‘Praxisgebuehr’)? A cross sectional analysis of socio-economic and health related factors.  BMC Health Serv Res. 2008;  8 232
• 16 Schneeweiss S, Avorn J. A review of uses of health care utilization databases for epidemiologic research on therapeutics.  J Clin Epidemiol. 2005;  58 (4) 323-337
• 17 Schneeweiss S. Developments in post-marketing comparative effectiveness research.  Clin Pharmacol Ther. 2007;  82 (2) 143-156
• 18 Stock SA, Redaelli M, Wendland G. et al . Diabetes – prevalence and cost of illness in Germany: a study evaluating data from the statutory health insurance in Germany.  Diabet Med. 2006;  23 (3) 299-305
• 19 von Ferber L, Köster I, Hauner H. Kosten der antihyperglykämischen Behandlung des Diabetes mellitus Einfluss von Lebensalter, Therapieart und Komplikationsstatus: Ergebnisse der KoDiM-Studie 2001.  Med Klin (Munich). 2006;  101 (5) 384-393
• 20 von Ferber L, Köster I, Hauner H. Medical costs of diabetic complications total costs and excess costs by age and type of treatment results of the German CoDiM Study.  Exp Clin Endocrinol Diabetes. 2007;  115 (2) 97-104
• 21 Werner A, Reitmeir P, John J. Kassenwechsel und Risikostrukturausgleich in der gesetzlichen Krankenversicherung – empirische Befunde der Kooperativen Gesundheitsforschung in der Region Augsburg (KORA).  Gesundheitswesen. 2005;  67 (S 01) S158-S166

Correspondence