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

Ann Epidemiol. 2005 Nov;15(10):756-61. doi: 10.1016/j.annepidem.2005.02.009. Epub 2005 Jun 15.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Decision Making
  • Female
  • Germany
  • Health Policy
  • Health Services Accessibility*
  • Humans
  • Insurance Coverage
  • Insurance, Health*
  • Male
  • Middle Aged
  • Migraine Disorders / drug therapy
  • Models, Theoretical
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care
  • Sumatriptan / therapeutic use
  • Vasoconstrictor Agents / therapeutic use


  • Vasoconstrictor Agents
  • Sumatriptan