[Health inequalities in a health system with two full insurance schemes? : Secondary analyses of the microcensus survey among insured persons of the statutory and private health insurance in Germany].

Introduction: The German healthcare system is characterised by the parallelism of private health insurance (PKV) and statutory health insurance (GKV). This constellation of two full insurance systems with simultaneous mandatory health insurance is unique worldwide. This study aims to gain new scientific findings on health inequalities.

Method: The secondary data analysis of the representative 2021 and 2022 microcensus survey (including the European Union Statistics on Income and Living Conditions) uses correlation and regression analyses.

Results: Comparative analyses reveal significant differences in socio-demographic characteristics and employment history between PKV and GKV and verify health inequalities between the two groups. Considering socio-demographic factors, logistic regression analyses show that the probability of very good or good self-rated health is twice as high for those with PKV compared to those with GKV (OR = 2.09). The likelihood of health impairments (OR = 0.53) and chronic diseases (OR = 0.64) is reduced by almost half. Despite having similar subjective needs for healthcare, those with PKV consulted medical specialists and dentists more frequently, while those with GKV consulted family doctors or general practitioners more frequently. People with PKV displayed healthier behaviours than those with GKV with regard to tobacco consumption, exercise and diet. However, they consumed more alcohol. People with GKV were more likely than those with PKV to report health expenditure and out-of-pocket payments as a "major burden", especially for dental care (10.0% vs. 4.1%).

Discussion: The results have implications for the design of healthcare systems and are relevant for prevention and health reporting.