Accessing a new medication in Germany: A novel approach to assess a health insurance-related barrier

Karl J. Krobot, Jay S. Kaufman, Dale B. Christensen, John S. Preisser, William C. Miller, Michel A. Ibrahim

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


PURPOSE: Knowledge of the existence, position, and magnitude of barriers to equitable healthcare is an important consideration in shaping healthcare policies. METHODS: The authors developed a novel three-dimensional person-time-related hurdle model and followed a cohort of 7358 statutorily (SHI) and 457 privately health insured (PHI) patients with migraine headaches at 377 primary-care practices (MediPlus, IMS Health) in the second to fourth year of the HealthCare Structural Reform Act in Germany. RESULTS: For SHI compared with PHI migraine patients, there was a hurdle to receiving sumatriptan at all (2.4-fold lower hazard, 95% confidence interval, 1.8-3.2). Among patients who received sumatriptan, frequency and intensity of use differed only minimally between SHI and PHI patients. CONCLUSIONS: These findings have implications for healthcare researchers and healthcare policies. The framework extends traditional hurdle models and can serve as a model for quantifying barriers to receipt of services under different funding policies.

Original languageEnglish (US)
Pages (from-to)756-761
Number of pages6
JournalAnnals of epidemiology
Issue number10
StatePublished - Nov 2005
Externally publishedYes


  • Delivery of Healthcare
  • Epidemiologic Methods
  • Health Insurance

ASJC Scopus subject areas

  • Epidemiology


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