This paper analyses the impact of type of insurance, income and reason for appointment on waiting time for an appointment and waiting time in the physician's practice in the outpatient sector. Data was obtained from a German patient survey conducted between 2007 and 2009. We differentiated between general practitioner (GP) and specialist and controlled for socioeconomic, structural and institutional characteristics as well as interactions between type of insurance and control variables. Our results reveal that private health insurance plays a significant role in faster access to care at GP and specialist practices. Access to care is also highly influenced by the reason for an appointment. We also found that increased income had a negative effect on waiting time in practices and on waiting time for an appointment in GP practices. Whether inequalities in access to health care also impact overall quality of treatment needs to be investigated in future research.
Marfan Syndrome faces significant problems of quality of health care, as although the requisite quantity of health care resources is available, this does not affect delay in diagnosis. Information technology might foster valuable networking among physicians treating such cases along with holistic assessment of symptoms as they occur.
On the one hand, the use of special criteria for drug admission, HTA, and reimbursement promotes R&D for orphan drugs. On the other hand, high opportunity costs arise, because huge efforts are made for a minority of patients. A solution for this moral dilemma may be the application of "rule of rescue" or of "no cure, no pay" programmes.
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