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Krobot, Karl J.; Kaufman, Jay S.; Christensen, Dale B.; Preisser, John S.; Miller, William C.; & Ibrahim, Michel A. (2005). Accessing a New Medication in Germany: A Novel Approach to Assess a Health Insurance-Related Barrier. Annals of Epidemiology, 15(10), 756-761.


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.


Reference Type

Journal Article

Year Published


Journal Title

Annals of Epidemiology


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