The German health care reform of 2004 imposes a charge of 10 Euro for the ﬁrst visit to a doctor in each quarter of the year. At ﬁrst glance, there is no inhibiting effect of this fee on utilization in the German Socio-Economic Panel. However, this study reveals that the true effect is diluted by a special characteristic of the fee. Exploiting random variation in the interview date, this study ﬁnds a substantial effect of the new fee on the probability of visiting a physician. In addition, the identiﬁcation strategy makes it possible to disentangle this effect from the inﬂuence of the contemporaneous increase of copayments for prescription drugs.