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This study is the first to estimate the price elasticities of demand for both medical rehabilitation programs and treatment at health spas. In Germany, the Statutory Health Insurance (SHI) covers both forms of therapy if administered in authorized medical facilities on referral from a physician. While health resort stays are prescribed to recover from general symptoms of poor health and are preventive in character, medical rehabilitation implies recovering from a specific illness or accident. From 1997 onwards, the German government more than doubled the copayments for both types of health care services from DM 12 (e6.14) to DM 25 (e12.78) per day for those insured under the SHI. Using longitudinal microdata from the German Socio-Economic Panel Study (SOEP), this exogenous price variation allows us to study the causal effects on demand, since we have a sound control group available. The data suggest that pull-forward effects in 1996 accounted for up to one-fifth of the subsequent decrease in demand. Taking this anticipation effect into account, we show that the reform induced a decrease in total demand of about 20 percent. We estimate the price elasticity for rehabilitation programs that aim at preventing work incapacity to be about -0.15, whereas the elasticity for rehabilitation programs for recovery from work accidents lies around -0.30. In contrast, the price elasticity for treatment at health spas is elastic and lies between -1 and -2.5.

Am 1. Januar 1997 trat eine Krankengeldkürzung von 80 auf 70 Prozent des Bruttoeinkommens in Kraft. Ab der siebten Woche erhalten gesetzlich Versicherte Krankengeld, sie gelten als langzeitkrank. Berechnungen auf Basis des Sozio-oekonomischen Panels (SOEP) zeigen, dass durch diese Maßnahme innerhalb von zehn Jahren rund fünf Milliarden Euro von den Langzeitkranken zugunsten der übrigen Versicherten umverteilt wurden. Dies trägt - wie von der Politik gewünscht - dazu bei, die Beitragssätze der gesetzlichen Krankenversicherung stabil zu halten, wenngleich der Effekt mit zuletzt 0,04 Beitragspunkten marginal ist. Durch die Krankengeldkürzung verlieren Langzeitkranke durchschnittlich 250 Euro pro Krankheitsepisode. Die Kürzung hat ursächlich nicht dazu geführt, dass die Zahl der Langzeitkrankheitsfälle von 1993 bis 2006 von 2,3 auf 1,4 Millionen gesunken ist.

This study is the first to estimate the price elasticities of demand for both medical rehabilitation programs and treatment at health spas. In Germany, the Statutory Health Insurance (SHI) covers both forms of therapy if administered in authorized medical facilities on referral from a physician. While health resort stays are prescribed to recover from general symptoms of poor health and are preventive in character, medical rehabilitation implies recovering from a specific illness or accident. From 1997 onwards, the German government more than doubled the copayments for both types of health care services from DM 12 (e6.14) to DM 25 (e12.78) per day for those insured under the SHI. Using longitudinal microdata from the German Socio-Economic Panel Study (SOEP), this exogenous price variation allows us to study the causal effects on demand, since we have a sound control group available. The data suggest that pull-forward effects in 1996 accounted for up to one-fifth of the subsequent decrease in demand. Taking this anticipation effect into account, we show that the reform induced a decrease in total demand of about 20 percent. We estimate the price elasticity for rehabilitation programs that aim at preventing work incapacity to be about -0.15, whereas the elasticity for rehabilitation programs for recovery from work accidents lies around -0.30. In contrast, the price elasticity for treatment at health spas is elastic and lies between -1 and -2.5.