Ethnic and Social Inequalities in Access to Health Care: Evidence from a Nation-Wide Field Experiment in Germany

Inequalities in health care access are a potentially important driver of social and ethnic inequalities in health. We conducted a large nation-wide field experiment to assess discrimination in accessing German private practices in five medical specialties (general practitioners, pediatricians, radiologists, dermatologists, and psychotherapists). Fictitious patients contacted approximately 7,000 practices by email, describing their condition and requesting an appointment as soon as possible. Patients with German-sounding names received a positive response in 50.5% and were offered a concrete appointment in 19.7% of cases. These numbers are substantially lower for patients with Turkish-sounding (44.4/15.4%) and Nigerian-sounding names (43.3%/16.1%). Positive response and appointment offer rates were also substantially higher for patients with a doctoral title (as opposed to no title) and for those with private (as opposed to statutory) insurance, with higher doctor remuneration for treating privately insured patients likely being a primary driver of the latter effect. Interactive specifications indicate that minority-ethnicity patients benefit less from having private insurance or a doctoral title than patients with German-sounding names, a result that is at odds with a simple statistical discrimination interpretation of ethnicity effects. Further analyses will explore effect heterogeneity in terms of physician/patient interactions (e.g., according to name-proxied physician gender and migration background) and contextual variation (e.g., according to physician density as a measure of competition and right-wing vote shares as indicators of local anti-immigrant sentiment).