Attitudes towards the dual health insurance system and inequalities in health care in Germany - results of a population survey.

backgroundIn Germany, type of health insurance is an important aspect of health care inequalities because there is a dual structure of statutory and private health insurance and there are incentives for a preferential treatment of privately insured patients. Two questions will be addressed in the study: What are the public attitudes towards the dual system of health insurance and inequalities in health care between those with statutory and private insurance? Are these attitudes associated with socio-demographic characteristics, health insurance and political party preferences?

methodsBased on a random sample, an online survey among the adult population (18 + years) in Germany was conducted (N = 2,201). Attitudes towards statutory and private health insurance were assessed using four items. Two items related to inequalities in access and quality of care; two were aimed at the system structure and remuneration. Age, gender, education, migration history, region of residence, health insurance and political party preference were included in the analyses as predictors.

resultsAbout 77% of respondents agreed with the statement that all insured persons in Germany have the same access to medically necessary care. Women were less convinced in this respect. Just over 20% agreed with the statement that people with statutory and private health insurance receive the same quality of medical care. Agreement was particularly high among men, older people and those with private insurance. Almost 80% were in favor of abolishing the coexistence of statutory and private health insurance. Agreement was lower among privately insured people and supporters of the liberal party; however, even in these subgroups, a majority of over 60% were in favor of abolition. Just over 15% found the different remuneration of services for those with statutory and private insurance acceptable. Agreement was significantly higher among older people and those with private insurance.

conclusionsA clear majority of the German population perceives inequalities in the quality of medical care between those with statutory or private health insurance and is in favor of abolishing the dual system of statutory and private health insurance. These majorities can be found in all socio-demographic subgroups and across all political party lines.