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Table 1 Co-payments and user charges in the German SHI

From: The role of consumer choice in out-of-pocket spending on health

Service

Coverage and required co-payments

requirement

incentive

medicines

    prescribed medicines

co-insurance of 5-10€ per package (10% up to reference price) + difference between actual and reference price

moderate

moderate

    non-prescribed medicines

no coverage

high

moderate

medical goods and equipment

    prescribed medical goods

co-insurance of 10%, max. 10€ per month

moderate

moderate

    non-prescribed medical goods

no coverage

high

moderate

    medical equipment and medical aids

basic options covered with 10% co-insurance, maximum 10€ per month

high

high

dental care

    dental care services

free if necessary and effective, additional services not covered

none

moderate

    materials for crowns and dentures

partial reimbursement, co-payments can be several hundred Euros even for standard care (Regelversorgung), hardship provisions for poor households can be granted

high

high

ambulatory care

    ambulatory medical services

free if deemed necessary and effective (then fully covered by SHI)

none

moderate

    admission fee

user charge of 10€ per 3 months from 2004–2012

moderate

none

    referred services

free if prescribed, no coverage otherwise

none

moderate

inpatient care

daily fee of 10€ for a maximum 28 days per year, additional services (e.g. single bed rooms) not covered

moderate

moderate

  1. Coverage, requirement to pay for necessary and effective (here: covered) healthcare and incentive to pay extra in the German SHI, assessment of requirement and incentive to pay by the authors. Spending categories correspond to those included in the EVS data