However, after research studies by the Forschungsinstitut zur Zukunft der Arbeit (Research Institute for the Future of Labor) showed the copayment system was ineffective in reducing doctor visits, it was voted out by the Bundestag in 2012. Despite attempts to contain costs, overall health care expenditures rose to 10.7% of GDP in 2005, comparable to other western European nations, but substantially less than that spent in the U.S. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the number of hospital days as opposed to procedures or the patient's diagnosis.
The average length of hospital stay in Germany has decreased in recent years from 14 days to 9 days, still considerably longer than average stays in the U.S. For chronically ill patients, the co-payment limit is 1% including any dependant living in their home. For example, Techniker Krankenkasse-insured members above 18 years pay the copayments costs for some medicines, therapeutic measures and appliances such as physiotherapy and hearing aids up to the limit of 2% of the family's annual gross income. The German healthcare system had introduced copayments in the late 1990s in an attempt to prevent overutilization and control costs. However, a copay may also discourage people from seeking necessary medical care, and higher copays may result in non-use of essential medical services and prescriptions, thus rendering someone who is insured effectively uninsured because they are unable to pay higher copays. In health systems with prices below the market clearing level in which waiting lists act as rationing tools, copayment can serve to reduce the welfare cost of waiting lists. It may be a small portion of the actual cost of the medical service but is meant to deter people from seeking medical care that may not be necessary, e.g., an infection by the common cold. Insurance companies use copayments to share health care costs to prevent moral hazard. Copayments do not usually contribute towards any policy out-of-pocket maximum, whereas coinsurance payments do. It must be paid before any policy benefit is payable by an insurance company. It is technically a form of coinsurance, but is defined differently in health insurance where a coinsurance is a percentage payment after the deductible up to a certain limit. It may be defined in an insurance policy and paid by an insured person each time a medical service is accessed. ( February 2017) ( Learn how and when to remove this template message)Ī copayment or copay (called a gap in Australian English) is a fixed amount for a covered service, paid by a patient to the provider of service before receiving the service. You may improve this article, discuss the issue on the talk page, or create a new article, as appropriate. The examples and perspective in this article deal primarily with the United States and Germany and do not represent a worldwide view of the subject.
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