Ambulatory care at the end of a billing period

The ambulatory physician payment system in the German Social Health Insurance (SHI) offers incentives to reduce practice activity at the end of a billing period. Most services within a period are reimbursed at full cost only up to a certain threshold. Furthermore, capitated payments make follow-up treatments within a billing period less profitable. Using claims data from Germany's largest sickness fund with about nine million members, we find a decrease of all services limited by a threshold at the end of a billing period and an immediate increase at the beginning of the following period. For services that are not limited, we do not find an effect. An increase of ambulatory emergencies at the end of a billing period suggests a negative welfare effect for patients.