• Melanie Neumann, Jozien Bensing, Markus Wirtz, Ansgar Wübker, Christian Scheffer, Diethard Tauschel, Friedrich Edelhäuser, Nicole Ernstmann, and Holger Pfaff.
• Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophic Medicine, Integrated Curriculum for Anthroposophic Medicine, Faculty for Health, Private University of Witten/Herdecke, Germany. melanie.neumann@uni-wh.de
• Patient Educ Couns. 2011 Aug 1;84(2):208-16.

ObjectiveWe hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI).MethodsA postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects.ResultsPHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE.ConclusionsOur findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE.Practical ImplicationsHealth policy should discuss these findings in terms of equality in receiving high-quality care.Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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