The dramatically rising health expenditures have become a matter of prime concern. Using a rich panel dataset this paper contributes to this debate by investigating factors determining the demand for hospitalization in Germany. While most previous studies have found a significant impact of social insurance on the demand for hospital trips, the empirical results presented here cast doubts on the role of those economic incentives. There are also important differences in the hospitalization behaviour of men and women, and between the full sample and those with chronic conditions, which have been neglected by the literature. © 1997 John Wiley & Sons, Ltd.