Moral hazard and statutory health insurance: How members of the statutory health insurance scheme perceive and evaluate opportunities for an over-utilization of health care benefits

In the course of the conflicts over the reform of statutory health insurance in Germany (Gesetzliche Krankenversicherung) complaints about moral hazard-behaviour on the part of the insured were repeatedly raised and linked to the demand for expanding managerial incentives aimed at reducing the consumption of health care benefits (copayments). Yet not only the need for assessing the consequences of moral-hazard behaviour has been a contested issue; the assumption of intended or 'unconscious' increases in the consumption of health care benefits (induced by the insured) has also been debated. However, critics and supporters of the assumption of moral-hazard behaviour, i.e. of the increased consumption thesis, neglect the perceptions and dispositions of the insured. In contrast the article, based on qualitative interviews examines how members of the statutory health insurance scheme assess the opportunities and incentives for the consumption of health care benefits which are not defined as 'medically necessary' by the physicians. The analysis proceeds in two stages: First, it analyzes how the respondents perceive the behaviour of the 'others insured' and examines the consequences in terms of their acceptance of the statutory health insurance scheme and their 'willingness to show solidarity' (Solidaritatsbereitshaft). The results suggest that the 'semantics of abuse' polarize the dispositions of the insured. Second, it is discussed to what extent and why the respondents resort to 'deliberate over-utilization'. Only a minor propensity for moral-hazard behaviour was found to exist. However, this finding cannot be explained by the insured having moral scruples. Instead, a lack of attractive opportunities accounts for this phenomenon.