[Morbidity Differences by Health Insurance Status in Old Age]

Area of Science:

• Gerontology
• Health Economics
• Public Health

Background:

• Morbidity disparities among older adults with private versus statutory health insurance in Germany are under-researched.
• Understanding these differences is crucial for assessing the equity of healthcare access and outcomes in aging populations.

Purpose of the Study:

• To investigate and quantify morbidity differences between older individuals enrolled in private versus statutory health insurance schemes in Germany.
• To explore the influence of socioeconomic factors, particularly income, on these observed morbidity variations.

Main Methods:

• Utilized data from the ESTHER prospective cohort study in Saarland, Germany, with two follow-up waves (3-year interval).
• Assessed participant morbidity using the Cumulative Illness Rating Scale for Geriatrics (CIRS-G) via general practitioners (GPs).
• Employed a between-subject estimator to quantify inter-individual variation, adjusting for age, sex, education, family status, and income.

Main Results:

• Initially, private health insurance members showed lower morbidity scores compared to statutory health insurance members.
• This association was substantially attenuated when income was included in the regression models.
• A statistically significant difference persisted for women, but not for men, after income adjustment.

Conclusions:

• Income differences partially explain the observed morbidity variations between older adults in private and statutory health insurance.
• The findings underscore the critical role of model specification, particularly the inclusion of socioeconomic determinants like income, in understanding the relationship between health insurance type and morbidity.