nep-hea New Economics Papers
on Health Economics
Issue of 2015‒06‒13
forty papers chosen by
Yong Yin
SUNY at Buffalo

  1. Child Mortality in the LDCs: The Role of Trade, Institutions and Environmental Quality By Faqin Lin; Nicholas C.S. Sim; Ngoc Pham
  2. Do More of those in Misery Suffer From Poverty, Unemployment or Mental Illness? By Sarah Flèche; Richard Layard
  3. Data Uncertainty in Markov Chains: Application to Cost-Effectiveness Analyses of Medical Innovations By Goh, Joel; Bayati, Mohsen; Zenios, Stefanos A.; Singh, Sundeep; Moore, David
  4. The Effects of Publicity on Demand: The Case of Anti-cholesterol Drugs By Andrew Ching; Robert Clark; Ignatius Horstmann; Hyunwoo Lim
  5. Quantifying the Impacts of Limited Supply: The Case of Nursing Homes By Andrew Ching; Fumiko Hayashi; Hui Wang
  6. The Effect of Statutory Sick Pay Regulations on Workers' Health By Halla, Martin; Pech, Susanne; Zweimüller, Martina
  7. The Effect of Changes in the Statutory Minimum Working Age on Educational, Labor and Health Outcomes By Jimenez-Martin, Sergi; Vall-Castello, Judit; del Rey, Elena
  8. Association of Participation in the Supplemental Nutrition Assistance Program and Psychological Distress By Vanessa M. Oddo; James Mabli
  9. Determinants of Cesarean Deliveries in Pakistan By Saman Nazir
  10. Poverty and transitions in health By Adena, Maja; Myck, Michal
  11. Macroeconomic crunches during working years and health outcomes later in life By Antonova, Liudmila; Bucher-Koenen, Tabea; Mazzonna, Fabrizio
  12. An Overview of the Stratified Economics of Stratified Medicine By Mark R. Trusheim; Ernst R. Berndt
  13. The Impact of Pharmaceutical Innovation on Premature Cancer Mortality in Canada, 2000-2011 By Frank R. Lichtenberg
  14. Intellectual Property Rights and Innovation: Evidence from Health Care Markets By Heidi L. Williams
  15. Effects of Income Inequality on Population Health and Social Outcomes at the Regional Level in the EU By Sebastian Leitner
  16. Does Reference Pricing Drive Out Generic Competition in Pharmaceutical Markets? Evidence from a Policy Reform By Kurt R. Brekke; Chiara Canta; Odd Rune Straume
  17. Defining hospital markets: An application to the German hospital sector By Hentschker, Corinna; Schmid, Andreas; Mennicken, Roman
  18. Nursing home prices and quality of care: Evidence from administrative data By Reichert, Arndt R.; Stroka, Magdalena A.
  19. The mental and physical burden of caregiving: Evidence from administrative data By Stroka, Magdalena A.
  20. Drug oversupply in nursing homes: An empirical evaluation of administrative data By Stroka, Magdalena A.
  21. Altruism heterogeneity and quality competition among healthcare providers By Kairies-Schwarz, Nadja
  22. Does the letter matter (and for everyone)? Quasi-experimental evidence on the effects of home invitation on mammography uptake By Carrieri, Vincenzo; Wuebker, Ansgar
  23. Does hospital reputation influence the choice of hospital? By Pilny, Adam; Mennicken, Roman
  24. Long-term care insurance and carers' labor supply: A structural model By Geyer, Johannes; Korfhage, Thorben
  25. Selective-referral and unobserved patient heterogeneity: Bias in the volume-outcome relationship By Hentschker, Corinna; Mennicken, Roman
  26. Sick of your job? Negative health effects from non-optimal employment By Kleibrink, Jan
  27. Mergers and acquisitions in the German hospital market: Who are the targets? By Pilny, Adam
  28. Choice of received long-term care: Individual responses to regional nursing home provisions By Pilny, Adam; Stroka, Magdalena A.
  29. Sorting into physician payment schemes: A laboratory experiment By Brosig-Koch, Jeannette; Kairies-Schwarz, Nadja; Kokot, Johanna
  30. Small cash rewards for big losers: Experimental insights into the fight against the obesity epidemic By Augurzky, Boris; Bauer, Thomas K.; Reichert, Arndt R.; Schmidt, Christoph M.; Tauchmann, Harald
  31. How do consumers choose health insurance? An experiment on heterogeneity in attribute tastes and risk preferences By Kairies-Schwarz, Nadja; Kokot, Johanna; Vomhof, Markus; Wessling, Jens
  32. How health plan enrollees value prices relative to supplemental benefits and service quality By Bünnings, Christian; Schmitz, Hendrik; Tauchmann, Harald; Ziebarth, Nicolas R.
  33. The effects of introducing mixed payment systems for physicians: Experimental evidence By Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel
  34. Communication problems? The role of parent-child communication for the subsequent health behavior of adolescents By Avdic, Daniel; Büyükdurmus, Tugba
  35. The Relationship between Healthcare Expenditure and Disposable Personal Income in the US States: A Fractional Integration and Cointegration Analysis By Guglielmo Maria Caporale; Juncal Cunado; Luis A. Gil-Alana; Rangan Gupta
  36. Poor Health Reporting : Do Poor South Africans Underestimate Their Health Needs? By Laura Rossouw
  37. Spillover Effects of Early-Life Medical Interventions By Breining, Sanni; Daysal, N. Meltem; Simonsen, Marianne; Trandafir, Mircea
  38. Peer Effects, Fast Food Consumption and Adolescent Weight Gain By Fortin, Bernard; Yazbeck, Myra
  39. Does Daylight Saving Time Really Make Us Sick? By Jin, Lawrence; Ziebarth, Nicolas R.
  40. US Health and Aggregate Fluctuations By Aleksandar Vasilev

  1. By: Faqin Lin (Central University of Finance and Economics (CUFE)); Nicholas C.S. Sim (School of Economics, University of Adelaide); Ngoc Pham (School of Economics, University of Adelaide)
    Abstract: Child mortality is a persistent problem for the worldÂ’s least developed countries (LDCs). Given that trade fosters economic development, one plausible solution is to raise the low levels oftrade in the LDCs, but how effective this approach might be could depend on the quality of institutions. In this paper, we use a novel instrumental variable approach to estimate the effect that trade might have on child mortality in the LDCs. We find that trade does not lead to lower levels of child mortality. In fact, in autocratic LDCs, trade could even cause child mortality to increase as we find that pollution, which adversely affects health, may rise with trade.
    Keywords: Child Mortality, Trade, Institutions, Environment, Least Developed Countries
    JEL: I3 O1 F18 P16
    Date: 2015–06
  2. By: Sarah Flèche; Richard Layard
    Abstract: Studies of deprivation usually ignore mental illness. This paper uses household panel data from the USA, Australia, Britain and Germany to broaden the analysis. We ask first how many of those in the lowest levels of life-satisfaction suffer from unemployment, poverty, physical ill health, and mental illness. The largest proportion suffer from mental illness. Multiple regression shows that mental illness is not highly correlated with poverty or unemployment, and that it contributes more to explaining the presence of misery than is explained by either poverty or unemployment. This holds both with and without fixed effects.
    Keywords: Mental health, life-satisfaction, wellbeing, poverty, unemployment
    JEL: I1 I3 I31 I32
    Date: 2015–06
  3. By: Goh, Joel (Stanford University); Bayati, Mohsen (Stanford University); Zenios, Stefanos A. (Stanford University); Singh, Sundeep (Stanford University); Moore, David (Stanford University)
    Abstract: Cost-effectiveness studies of medical innovations often suffer from data inadequacy. When Markov chains are used as a modeling framework for such studies, this data inadequacy can manifest itself as imprecise estimates for many elements of the transition matrix. In this paper, we study how to compute maximal and minimal values for the discounted value of the chain (with respect to a vector of state-wise costs or rewards) as these uncertain transition parameters jointly vary within a given uncertainty set. We show that these problems are computationally tractable if the uncertainty set has a row-wise structure. Conversely, we prove that if the row-wise structure is relaxed slightly, the problems become computationally intractable (NP-hard). We apply our model to assess the cost-effectiveness of fecal immunochemical testing (FIT), a new screening method for colorectal cancer. Our results show that despite the large uncertainty in FIT's performance, it is highly cost-effective relative to the prevailing screening method of colonoscopy.
    Date: 2015
  4. By: Andrew Ching; Robert Clark; Ignatius Horstmann; Hyunwoo Lim
    Abstract: Over the past ten years there has been increased recognition of the importance of publicity as a means of generating product awareness. Despite this, previous research has seldom investigated the impact of publicity on demand. We contribute to the literature by (i) proposing a new method for the interpretation of publicity data, one that maps the information in news articles (or broadcasts) to a multi-dimensional attribute space; (ii) investigating how different types of publicity affect demand; and (iii) investigating how different types of publicity interact with firms? own marketing communication efforts. We study these issues for statins. We find that publicity plays an important role both for expanding the market for statins and for determining which statins patients/physicians choose. We also find evidence that publicity can serve as either a substitute or a complement for traditional marketing channels depending on the complexity of the information type. We argue that the interaction results are driven by the relative strengths of the corroborative and rational inattention functions in publicity. These results suggest that managers should be aware of the interactions between publicity and traditional marketing channels in order to better determine how to allocate their marketing expenditures.
    Keywords: publicity, informative detailing and advertising, information complements and substitutes, corroborative evidence, rational inattention, demand, prescription drugs
    JEL: D12 I11 L65 M30 M31
    Date: 2015–06
  5. By: Andrew Ching; Fumiko Hayashi; Hui Wang
    Abstract: This paper develops a new estimation method that accounts for excess demand and the unobserved component of product quality. We apply our method to study the Wisconsin nursing home market in 1999, and find that nearly 20% of elderly qualified for Medicaid were rationed out. However, our counterfactual experiment shows that the net welfare gain of fulfilling all nursing home demands may be small, because the welfare gain to Medicaid patients could be largely offset by the increase in Medicaid expenditures. We also find that a 1% increase in quality would crowd out 3.2% Medicaid patients in binding nursing homes.
    Keywords: rationing, excess demand, capacity constraints, demand estimation, nursing homes, unobserved quality
    JEL: C15 C35 D45 I11 I18
    Date: 2015–06
  6. By: Halla, Martin (University of Innsbruck); Pech, Susanne (University of Linz); Zweimüller, Martina (University of Linz)
    Abstract: Social insurance programs typically comprise sick leave insurance. An important policy parameter is how the cost of sick leave are shared between workers, firms, and the social security system. We show that this sharing rule affects not only absence behavior, but also workers' subsequent health. To inform our empirical analysis we propose a simple model, where workers' absence decision is taken conditional on the sharing rule, health, and a dismissal probability. Our empirical analysis is based on high-quality administrative data sources from Austria. Identification is guaranteed by idiosyncratic variation in the sharing rule (caused by different policy reforms and sharp discontinuities at certain tenure levels and firm sizes). An increase in either the workers' or the firms' cost share (both at the public expense) decrease the number of sick leave days. Variations in the workers' cost are quantitatively more important (by a factor of about two). Policy-induced variation in sick leave has a significant effect on subsequent health (care cost). The average worker in our sample is in the domain of presenteeism, i.e. an increase in sick leave (due to reductions in the workers' or the firms' cost share) would reduce health care cost.
    Keywords: statutory sick-pay regulations, sick leave, presenteeism, absenteeism, moral hazard, health care cost
    JEL: I18 J22 J38
    Date: 2015–05
  7. By: Jimenez-Martin, Sergi (Universitat Pompeu Fabra); Vall-Castello, Judit (Universitat Pompeu Fabra); del Rey, Elena (Universitat de Girona)
    Abstract: In this paper we explore the effects of a labor market reform that changed the statutory minimum working age in Spain in 1980. In particular, the reform raised the statutory minimum working age from 14 to 16 years old, while the minimum age for attaining compulsory education was kept at 14 until 1990. To study the effects of this change, we exploit the different incentives faced by individuals born at various times of the year before and after the reform. We show that, for individuals born at the beginning of the year, the probabilities of finishing both the compulsory and the post-compulsory education level increased after the reform. In addition, we find that the reform decreases mortality while young (16-25) for both genders while it increases mortality for middle age women (26-40). We provide evidence to proof that the latter increase is partly explained by the deterioration of the health habits of affected women. Together, these results help explain the closing age gap in life expectancy between women and men in Spain.
    Keywords: minimum working age, policy evaluation, education, mortality
    JEL: J01 I12
    Date: 2015–06
  8. By: Vanessa M. Oddo; James Mabli
    Abstract: This article assessed whether households’ participation in the Supplemental Nutrition Assistance Program (SNAP) was associated with improvements in well-being, as indicated by lower rates of psychological distress.
    Keywords: SNAP, Supplemental Nutrition Assistance Program, Psychological Distress
    JEL: I0 I1
    Date: 2015–06–01
  9. By: Saman Nazir (Pakistan Institute of Development Economics, Islamabad)
    Abstract: Role of cesarean section (C Section) is acknowledged worldwide to safe maternal and neonatal life, and especially in countries like Pakistan where maternal health care is not satisfactory. But there is a concern on rising rates of cesarean deliveries as it is found very high in urban areas of Pakistan that is about 25%. The current study focuses on the clinical, socio-economic and demographic determinants of cesarean deliveries in Pakistan. Pakistan Demographic and Health Survey 2012-13 has been used for both bi and multivariate analysis. Clinical factors are turned out to be important determinates of C section in Pakistan. Among socio-economic factors women who are educated, increasing age, rich, living in urban area, and receiving institutional antenatal care are at higher risk of having C section. Further qualitative research is needed to answer this question like, why woman with better socio economic profile have higher C section rates.
    Keywords: Cesarean Section, Maternal Health, Cesarean deliveries, Clinical Determinants, Socio-economic Determinants
    Date: 2015
  10. By: Adena, Maja; Myck, Michal (Munich Center for the Economics of Aging (MEA))
    Abstract: Using a sample of Europeans aged 50+ from twelve countries in the Survey of Health, Ageing and Retirement in Europe (SHARE) we analyse the role of poor material conditions as a determinant of changes in health over a four-year period. We find that poverty defined with respect to relative incomes has no effect on changes in health. However, broader measures of poor material conditions such as subjective poverty or low relative value of wealth significantly increase the probability of transition to poor health among the healthy and reduce the chance of recovery from poor health over the time interval analysed. In addition to this the subjective measure of poverty has a significant effect on mortality, increasing it by 40.3% among men and by 58.3% among those aged 50–64. Material conditions matter for health among older people. We suggest that if monitoring of poverty in old age and corresponding policy targets are to focus on the relevant measures, they should take into account broader definitions of poverty than those based only on relative incomes.
    JEL: I14 I32 J14
    Date: 2013–07–22
  11. By: Antonova, Liudmila; Bucher-Koenen, Tabea; Mazzonna, Fabrizio (Munich Center for the Economics of Aging (MEA))
    Abstract: We investigate the long-term effects of macroeconomic crises experienced during prime working age (20 to 50) on health outcomes later in life using data from eleven European countries. Experiencing a severe crisis in which GDP dropped by at least 1% significantly reduces health later in life. Specifically, respondents hit by such a shock rate their subjective health as worse, are more likely to suffer from chronic diseases and mobility limitations, and have lower grip strength. The effects are larger among low-educated respondents. Experiencing a crisis year decreases the probability of being in good health later in life equivalent to being two years older in the overall sample or four years older in the low-educated subsample. Highly educated respondents' health is not affected by economic crises and additionally economic booms have a positive effect on their health. An analysis of critical periods in life reveals that in particular crises experienced later in the career (between age 40 and 50) matter for health. Extensive robustness checks show that our results are not driven by general improvements in health during the post-war years.
    JEL: I15 J14 N14
    Date: 2014–12–19
  12. By: Mark R. Trusheim; Ernst R. Berndt
    Abstract: The economics of stratified medicine depend critically on setting the cut-off score of the companion diagnostic (CDx). This action integrates scientific, clinical, ethical and commercial considerations, and simultaneously determines the value of the stratified medicine to developers, providers, payers and patient. Setting a high cut-off ensures a larger response by excluding more non-responders but also denies treatment to patients who would respond. This creates ethical and clinical concerns, and limits market size. Setting a low cut-off includes more patients who can benefit but includes more non-responders with commensurate costs, side effects and lost time. CDx’s capture little value under current reimbursement and exclusivity protections. Combined with low CDx investment incentives for generic drug manufacturers, little CDx development occurs for older legacy drugs. Therefore payers face an asymmetric situation of novel stratified medicines raising public health and payers’ costs, but no CDx’s for legacy treatments to reduce costs. It would be in payers’ interests to rediscover their heritage of direct investment in diagnostic development.
    JEL: D04 D21 I11 I18 L11 L65
    Date: 2015–06
  13. By: Frank R. Lichtenberg
    Abstract: The premature cancer mortality rate has been declining in Canada, but there has been considerable variation in the rate of decline across cancer sites. I analyze the effect that pharmaceutical innovation had on premature cancer mortality in Canada during the period 2000-2011, by investigating whether the cancer sites that experienced more pharmaceutical innovation had larger declines in the premature mortality rate, controlling for changes in the incidence rate. The estimates imply that pharmaceutical innovation during the period 1985-1996 reduced the number of years of potential life lost to cancer before age 75 in 2011 by 105,366. The cost per life-year before age 75 gained from previous pharmaceutical innovation is estimated to have been 2730 USD. The evidence suggests that, even if these drugs had been sold at branded rather than generic prices, the cost per life-year gained would have been below 11,000 USD, a figure well below even the lowest estimates of the value of a life-year gained.
    JEL: C23 C33 I10 J11 J17 L65 O33
    Date: 2015–06
  14. By: Heidi L. Williams
    Abstract: A long theoretical literature has analyzed optimal patent policy design, yet there is very little empirical evidence on a key parameter needed to apply these models in practice: the relationship between patent strength and research investments. I argue that the dearth of empirical evidence on this question reflects two key challenges: the difficulty of measuring specific research investments, and the fact that finding variation in patent protection is difficult. I then summarize the findings of two recent studies which have made progress in starting to overcome these empirical challenges by combining new datasets measuring biomedical research investments with novel sources of variation in the effective intellectual property protection provided to different inventions. The first study, Budish, Roin, and Williams (forthcoming), documents evidence consistent with patents affecting the rate and direction of research investments in the context of cancer drug development. The second study, Williams (2013), documents evidence that one form of intellectual property rights on the human genome had quantitatively important impacts on follow-on scientific research and commercial development. I discuss the relevance of both studies for patent policy, and discuss directions for future research.
    JEL: I1 O3
    Date: 2015–06
  15. By: Sebastian Leitner (The Vienna Institute for International Economic Studies, wiiw)
    Abstract: This paper analyses the relationships between various measures of income inequality and variables describing population health and social outcomes at the regional level in the EU. Differences between the Central and East European new EU Member States (NMS) and non-NMS EU countries are highlighted. By applying fixed and random effects and cross-region regressions, we found negative relationships between income inequality and life expectancy, infant mortality, standardised death rates on various causes, rates of violent and property crime, rates of non-activity and early leave from education of young persons. The results indicate that redistributive policies might be an effective measure to reduce social harm and improve population health.
    Keywords: income inequality, population health, social phenomena, distribution, European Union, Central and Eastern Europe, regional analysis
    JEL: D31 I30
    Date: 2015–05
  16. By: Kurt R. Brekke (Department of Economics, Norwegian School of Economics); Chiara Canta (Department of Economics, Norwegian School of Economics); Odd Rune Straume (Universidade do Minho - NIPE)
    Abstract: In this paper we study the impact of reference pricing (RP) on entry of generic firms in the pharmaceutical market. For given prices, RP increases generic firms' expected profit, but since RP also stimulates price competition, the impact on generic entry is theoretically ambiguous. In order to empirically test the effects of RP, we exploit a policy reform in Norway in 2005 that exposed a subset of drugs to RP. Having detailed product-level data for a wide set of substances from 2003 to 2013, we find that RP increased the number of generic drugs. We also find that RP increased market shares of generic drugs, reduced the prices of both branded and generic drugs, and led to a (weakly significant) decrease in total drug expenditures. The reduction in total expenditures was relatively smaller than the reduction in average prices, reflecting the fact that lower prices stimulated total demand.
    Keywords: Pharmaceuticals; Reference pricing; Generic entry
    JEL: I11 I18 L13 L65
    Date: 2015
  17. By: Hentschker, Corinna; Schmid, Andreas; Mennicken, Roman
    Abstract: The correct definition of the product market and of the geographic market is a prerequisite for assessing market structures in antitrust cases. For hospital markets, both dimensions are controversially discussed in the literature. Using data for the German hospital market we aim at elaborating the need for differentiating the product market and at investigating the effects of different thresholds for the delineation of the geographic market based on patient flows. Thereby we contribute to the scarce empirical evidence on the structure of the German hospital market. We find that the German hospital sector is highly concentrated, confirming the results of a singular prior study. Furthermore, using a very general product market definition such as 'acute in-patient care' averages out severe discrepancies that become visible when concentration is considered on the level of individual diagnoses. In contrast, varying thresholds for the definition of the geographic market has only impact on the level of concentration, while the correlation remains high. Our results underline the need for more empirical research concerning the definition of the product market for hospital services.
    Keywords: hospital market,concentration,product market,geographic market,Germany
    JEL: L11 I11
    Date: 2014
  18. By: Reichert, Arndt R.; Stroka, Magdalena A.
    Abstract: There is widespread concern about the quality of care in nursing homes. Based on administrative data of a large health insurance fund, we investigate whether nursing home prices affect relevant quality of care indicators at the resident level. Our results indicate a significantly negative price effect on inappropriate and psychotropic medication. In contrast, we find no evidence for fewer painful physical sufferings for residents of nursing homes with higher prices.
    Abstract: Die in den letzten Jahren ins Blickfeld der Öffentlichkeit getretenen Probleme in Pflegeheimen führten zu dem vielfach geäußerten Verdacht der medikamentösen Ruhigstellung betreuungsbedürftiger Menschen in der stationären Pflege. Mit der vorliegenden Untersuchung soll ein Beitrag zum Abbau der derzeit noch bestehenden Wissensdefizite über den Zusammenhang zwischen dem Preis und der Qualität der stationären Pflegeleistungen geleistet werden. Auf Basis von Routinedaten der Techniker Krankenkasse werden hierzu neben der Inzidenz an Verletzungen sowie weiteren gesundheitlichen Beeinträchtigungen aufgrund äußerer Umstände die verordnete Dosis potenziell inadäquater Medikamente für ältere Menschen sowie weiterer Arzneistoffklassen (u.a. Psycholeptika) als Indikatoren der Ergebnisqualität herangezogen. Die Ergebnisse der Untersuchung zeigen einen negativen Effekt der Heimpreise auf Verschreibungen potenziell inadäquater und psychotropischer Medikamente.
    Keywords: quality of care,nursing homes,inappropriate medication,psychotropic drugs,panel data analysis
    JEL: I10
    Date: 2014
  19. By: Stroka, Magdalena A.
    Abstract: This study evaluates the mental and physical strain experienced by informal caregivers. Econometric problems due to individuals selecting themselves into informal care provision are tackled by using informative and detailed data from the largest sickness fund in Germany and applying propensity score matching techniques. The findings suggest that carers take more psychoactive drugs as well as analgesics and gastrointestinal agents. Thus, informal caregiving appears to be a burdensome task with implications for both mental and physical health.
    Abstract: Die vorliegende Studie verfolgt das Ziel der Aufdeckung von Opportunitätskosten die mit der Erbringung der informellen Pflege Angehöriger einhergehen und sich in der Verschlechterung des Gesundheitszustandes der pflegenden Personen äußern. Hierzu werden die Routinedaten Deutschlands größter Krankenkasse verwendet. Unter Rückgriff auf die Methode des Propensity Score Matchings liefert die Untersuchung Evidenz für eine höhere Einnahme von Psychopharmaka sowie Schmerz- und Verdauungsmitteln durch informelle Pfleger im Vergleich zu Personen ohne Pflegeverpflichtungen. Es scheint also, als dass informelle Pflege sowohl mit mentaler als auch physischer Gesundheitsbelastung einhergeht.
    Keywords: informal care,burden,drugs,propensity score matching
    JEL: I10
    Date: 2014
  20. By: Stroka, Magdalena A.
    Abstract: A widely discussed shortcoming of long-term care in nursing homes for elderly is the inappropriate or suboptimal drug utilization, in particular the utilization of psychotropic drugs. This paper estimates the effect of institutionalization on the drug intake of frail elderly using administrative data from the largest sickness fund in Germany. Difference-in-differences propensity score matching techniques are used to compare drug prescriptions of frail elderly who entered a nursing home with those who remained in the out-patient care system. The findings suggest that nursing home inhabitants receive more doses of antipsychotics, antidepressants and analgesics. The potential oversupply goes along with estimated drug costs of about 87 million per year.
    Abstract: Unter Rückgriff auf die Routinedaten Deutschlands größter Krankenkasse analysiert die vorliegende Studie die Unterschiede der in einem Jahr verschriebenen Dosen verschiedener Arzneistoffklassen im ambulanten und stationären Pflegebereich. Erstmalig in der Literatur werden dabei im Rahmen der Untersuchung von Verschreibungsunterschieden potenziell inadäquate Medikationen für ältere Menschen betrachtet. Die Ergebnisse des Difference-in-difference Propensity Score Matchings zeigen, dass im stationären Pflegebereich mehr Antipsychotika, Antidepressiva und Schmerzmittel verordnet werden als in der ambulanten Pflege. Diese potenzielle Überversorgung geht mit jährlichen Medikamentenkosten in Höhe von etwa 87 Millionen einher.
    Keywords: medication errors,patient safety,expenditures,drug over- and undersupply,medical costs
    JEL: I10
    Date: 2014
  21. By: Kairies-Schwarz, Nadja
    Abstract: New empirical evidence shows substantial heterogeneity in the altruism of healthcare providers. Spurred by this evidence, we build a spatial quality competition model with altruism heterogeneity. We find that more altruistic healthcare providers supply relatively higher quality levels and position themselves closer to the center. Whether the social planner prefers more or less horizontal differentiation is in general ambiguous and depends on the level of altruism. The more altruistic healthcare providers are, the more likely it is that the social planner prefers greater horizontal differentiation to offset costly quality competition.
    Abstract: Neue empirische Evidenz für Leistungsanbieter im Gesundheitswesen zeigt, dass es erhebliche Heterogenität im Grad des Altruismus gibt. Auf Basis dieser neuen Evidenz entwickeln wir ein räumliches Wettbewerbsmodell, in dem Leistungsanbieter mittels Qualität konkurrieren und das für Heterogenität im Grad des Altruismus erlaubt. Wir finden, dass Leistungsanbieter, die durch einen relativ höheren Grad an Altruismus gekennzeichnet sind, auch höhere Qualitäten anbieten und sich zentraler allokieren (niedrigere horizontale Differenzierung). Ob aus der sozialen Perspektive mehr oder weniger horizontale Differenzierung bevorzugt wird, hängt von dem Grad des Altruismus ab. Je höher der Grad des Altruismus, desto wahrscheinlicher ist es, dass der Sozialplaner mehr horizontale Differenzierung bevorzugt, um den Qualitätswettbewerb einzuschränken.
    Keywords: healthcare provider altruism and heterogeneity,quality competition
    JEL: H42 I11 I18 L13
    Date: 2014
  22. By: Carrieri, Vincenzo; Wuebker, Ansgar
    Abstract: We exploit regional variation in the availability of breast cancer screening policies and variations in age eligibility criteria across European regions to estimate the causal effect of home invitation on mammography uptake. We link administrative public data about regional breast cancer screening policies from various sources to individual Survey of Health Ageing and Retirement in Europe (SHARE) data. We find that home invitation increases mammography uptakes by almost 20 percentage points. At the same time, we find that home invitation reduces education-related inequalities but increases gradient in the use related to cognitive functions. In addition, significant effects on mammography use are found only when at least 50 per cent of the population is reached by the home invitation. Our results suggest that an exogenous informational shock affects preventive decisions especially among less informed individuals but the effectiveness of invitation is strongly reduced for women who are less able to process information.
    Abstract: In diesem Papier nutzen wir regionale Unterschiede im Zugang zu Brustkrebs-Screening-Programmen sowie regionale Unterschiede in den altersspezifischen Teilnahmebedingungen, um den kausalen Effekt von schriftlichen Einladungen auf die Teilnahme an Mammographie-Screening-Programmen zu untersuchen. Hierzu werden administrative regionale Daten zu Brustkrebs-Screening-Programmen herangezogen und mit Individualdaten des Survey of Health Ageing and Retirement (SHARE) verknüpft. Wir finden heraus, dass die Einladung zum Screening die Teilnahme am Screening um fast 20 Prozentpunkte erhöht. Gleichzeitig reduziert die Einladung zum Screening bildungsbezogene Ungleichheiten in der Inanspruchnahme, jedoch erhöht sie kognitiv bezogene Ungleichheiten. Signifikante Effekte auf die Mammographieteilnahme werden nur gefunden, wenn mindestens 50 Prozent der Bevölkerung eine Einladung erhält. Unsere Ergebnisse lassen schlussfolgern, dass ein durch die schriftliche Einladung ausgelöster exogener Informationsschock einen starken Einfluss auf Präventionsentscheidungen hat. Diese Schlussfolgerung gilt insbesondere für weniger informierte Personen. Demgegenüber ist die Einladung zum Screening nicht so effektiv, wenn die Frauen weniger in der Lage sind Informationen zu verarbeiten.
    Keywords: home invitation,preventive health care,quasi-experiment
    JEL: C10 I11 I14 I18
    Date: 2014
  23. By: Pilny, Adam; Mennicken, Roman
    Abstract: A number of recent empirical studies document significant effects of in-patient care quality indicators on the choice of hospital. These studies use either objective quality indicators based on quantitative figures, or if subjective reputation scores are used, scores based on the opinion of hospital market insiders. We contribute to the current debate by using a subjective reputation score resorting to patient perceptions and examine its impact on the choice of hospital of patients undergoing a coronary artery bypass graft (CABG) in Germany. Our results show that 76% of the patients value hospital reputation positively when choosing a hospital. Moreover, we find evidence for a trade-off between hospital reputation and travel time, i.e. a significant share of patients is willing to accept additional travel time to get a treatment in a hospital with better reputation. The average marginal effect for hospital reputation confirms this finding, since the magnitude of the effect strengthens for higher thresholds of travel time. The results are robust for different degrees of co-morbidities and admission status.
    Abstract: Eine Reihe jüngst veröffentlichter empirischer Studien hat nachgewiesen, dass Qualitätsindikatoren einen signifikanten Einfluss auf die Krankenhauswahl haben. Diese Studien haben entweder objektive Qualitätsindikatoren herangezogen, die auf quantitativen Größen beruhen, oder sofern subjektive Indikatoren herangezogen wurden, basierten diese auf der Meinung von Krankenhausmarktinsidern. Mit dieser Studie leisten wir einen Beitrag zur aktuellen Debatte, indem wir als Indikator die Reputation von Krankenhäusern verwenden, die auf der Meinung von ehemals behandelten Patienten basiert, und untersuchen dessen Einfluss auf die Krankenhauswahl von Patienten, die sich einer Koronararterien-Bypass-Operation in Deutschland unterzogen haben. Unsere Ergebnisse zeigen, dass die Reputation der Klinik bei 76 Prozent aller Patienten einen signifikanten Einfluss auf die Krankenhauswahl hat. Darüber hinaus finden wir empirische Evidenz für einen Trade-off zwischen Reputation und der Fahrzeit zum Klinikum. Ein signifikanter Anteil der Patienten ist folglich bereit, längere Fahrzeiten in Kauf zu nehmen, um in einer Klinik mit besserer Reputation behandelt zu werden. Die durchschnittlichen marginalen Effekte bestätigen diesen Befund insofern, als dass die Größenordnung des marginalen Effekts für Krankenhausreputation für längere Fahrzeiten stetig zunimmt. Die Ergebnisse sind robust für verschiedene Schweregrade und den Aufnahmestatus des Patienten.
    Keywords: hospital choice,hospital reputation,mixed logit model
    JEL: C25 D12 I11
    Date: 2014
  24. By: Geyer, Johannes; Korfhage, Thorben
    Abstract: In Germany, individuals in need of long-term care receive support through benefits of the long-term care insurance. A central goal of the insurance is to support informal care provided by family members. Care recipients can choose between benefits in kind (formal home care services) and benefits in cash. From a budgetary perspective family care is a cost-saving alternative to formal home care and to stationary nursing care. However, the opportunity costs resulting from reduced labor supply of the carer are often overlooked. We focus on the labor supply decision of family carers and the incentives set by the long-term care insurance. We estimate a structural model of labor supply and the choice of benefits of family carers. We find that benefits in kind have small positive effects on labor supply. Labor supply elasticities of cash benefits are larger and negative. If both types of benefits increase, negative labor supply effects are offset to a large extent.
    Abstract: Eines der zentralen Ziele der deutschen Pflegeversicherung ist die Unterstützung informeller Pflege durch Familienangehörige. Die Pflegeversicherung bietet anspruchsberechtigten Personen die Möglichkeit, zwischen verschiedenen Leistungen zur Unterstützung der häuslichen Pflege zu wählen. Pflegegeld kann entweder als Geldleistung direkt ausgezahlt werden oder als Sachleistung (in Form von formeller Pflege durch Pflegedienstleister) in Anspruch genommen werden. Werden ausschließlich die direkten Ausgaben der Pflegeversicherung berücksichtigt, erscheinen Geldleistungen und damit informelle Pflege durch Familienangehörige als kostengünstiger im Vergleich zu den teureren Alternativen der formellen häuslichen Pflege oder der stationären Pflege in Pflegeheimen. Unberücksichtigt bleiben dabei jedoch die Opportunitätskosten der informellen Pflege, die vor allem durch ein reduziertes Arbeitsangebot der Pflegenden entstehen können. Wir untersuchen deshalb die Veränderungen der Arbeitsangebotsentscheidung und des Pflegeverhaltens informell pflegender Haushaltsmitglieder durch veränderte Anreize der Pflegeversicherung. Dafür schätzen wir ein strukturelles Modell des Arbeitsangebots und der Nachfrage nach Leistungen aus der Pflegeversicherung. Unsere Ergebnisse zeigen kleine positive Arbeitsangebotseffekte durch eine Ausweitung der Sachleistungen und große negative Effekte durch eine Erhöhung der Geldleistungen. Kommt es zu einer simultanen Ausweitung beider Leistungen, gleichen sich die die gegenläufigen Effekte zu großen Teilen gegenseitig aus und der Arbeitsangebotseffekt bleibt moderat.
    Keywords: labor supply,long-term care,long-term care insurance,structural model
    JEL: J22 H31 I13
    Date: 2014
  25. By: Hentschker, Corinna; Mennicken, Roman
    Abstract: This paper examines the causal effect of the experience of a hospital with treating hip fractures (volume) on treatment outcome for patients. A full sample of administrative data from Germany for the year 2007 is used. We apply an instrumental variable approach to eliminate endogeneity concerns due to reverse causality and unobserved patient heterogeneity. As instruments for case volume we use the number of potential patients and the number of further hospitals in the region around every hospital. Our results indicate that after application of an IV regression of volume on outcome, volume significantly increases quality.
    Abstract: Dieser Beitrag analysiert den kausalen Effekt zwischen der Zahl der Fälle eines Krankenhauses und der Qualität der Behandlung für Patienten mit einer Hüftfraktur. Es werden administrative Daten aus Deutschland für das Jahr 2007 genutzt. Wir führen eine Instrumentenvariablenschätzung durch, um Endogenitätsprobleme durch umgekehrte Kausalität sowie durch ausgelassene Variablen zu eliminieren. Als Instrumente nutzen wir die Anzahl potenzieller Patienten sowie die Anzahl weiterer Krankenhäuser in der Umgebung von jedem Krankenhausstandort. Unsere Ergebnisse zeigen, dass die Fallzahl einen signifikanten Effekt auf die Behandlungsqualität hat und damit als eine Einflussgröße betrachtet werden kann, die die Qualität erhöht.
    Keywords: volume,hospital quality,mortality,instrumental variables
    JEL: I11 I12 I18
    Date: 2014
  26. By: Kleibrink, Jan
    Abstract: In an empirical study based on data from the German Socio-Economic Panel, the effect of job quality on individual health is analyzed. Extending previous studies methodologically to estimate unbiased effects of job satisfaction on individual health, it can be shown that low job satisfaction affects individual health negatively. In a second step, the underlying forces of this broad effect are disentangled. The analysis shows that the effects of job satisfaction on health run over the channels of job security and working hours above the individual limit. Job quality not only has a strong impact on mental health but physical health is affected as well. At the same time, health-damaging behavior including smoking and being overweight is not affected.
    Abstract: Dieser Beitrag untersucht empirisch den Effekt von Arbeitsplatzeigenschaften auf die individuelle Gesundheit. In einer breit angelegten ökonometrischen Studie wird auf Basis von Daten des Sozio-ökonomischen Panels gezeigt, dass niedrige Zufriedenheit mit dem Arbeitsplatz zu schlechterer Gesundheit führt. In einem weiteren Schritt werden die zugrunde liegenden Determinanten analysiert. Dabei kann gezeigt werden, dass Arbeitsplatzunsicherheit sowie ein Stundenpensum über dem individuellen Limit negative Gesundheitseffekte haben. Besonders betroffen ist die mentale Gesundheit. Allerdings gibt es auch signifikante Effekte auf die physische Gesundheit. Effekte auf gesundheitsschädigendes Verhalten, wie das Rauch- und Essverhalten, sind nicht zu finden.
    Keywords: individual health,job satisfaction
    JEL: I14 J24 J28
    Date: 2014
  27. By: Pilny, Adam
    Abstract: Since the introduction of the DRG system in 2004, the German hospital market experienced a stream of consolidations in terms of mergers and acquisitions, resulting in a decreasing number of hospital owners. In this study, I examine the ex-ante characteristics of hospitals prior to a merger or an acquisition occurring between 2005 and 2010 in Germany, predominantly focusing on the financial conditions of hospitals. The results reveal that hospitals with a higher probability of default and less liquid resources are more often the targets of acquisitions. On the other hand, hospitals with a lower equity-to-assets ratio exhibit a higher probability of merger. This pattern can be explained by different motives and rationales of hospital chains and potential investors.
    Abstract: Seit der Einführung des DRG-Systems im Jahr 2004 fand im deutschen Krankenhausmarkt eine Konsolidierung statt, die durch Fusionen und Akquisitionen geprägt gewesen ist. In deren Folge nahm die Anzahl der Träger im Krankenhausmarkt stetig ab. In dieser Studie werden die ex-ante Charakteristika von Krankenhäusern vor ihrer Fusion und Akquisition untersucht, wobei insbesondere der Fokus auf die finanzielle Lage der Kliniken gelegt wird. Die Ergebnisse zeigen, dass Krankenhäuser mit einer größeren Ausfallwahrscheinlichkeit und mit geringeren liquiden Mitteln häufiger von Akquisitionen betroffen sind. Dahingegen weisen Kliniken mit einer geringeren Eigenkapitalquote eine höhere Wahrscheinlichkeit auf fusioniert zu werden. Diese Ergebnisse lassen sich durch die Motive und Übernahmeabsichten seitens der Klinikketten und potenzieller Investoren erklären.
    Keywords: hospital market,mergers,acquisitions,consolidation
    JEL: I11 L33
    Date: 2014
  28. By: Pilny, Adam; Stroka, Magdalena A.
    Abstract: Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in the individual's decision-making process. In this study, we analyze the choice of received long-term care by explicitly taking the regional supply of nursing homes into account. When estimating a discrete choice model, we distinguish between four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home places, while controlling for physical and psychological conditions of the individual.
    Abstract: Die bisherige Literatur, die sich mit der Wahl der Pflegeform für die Langzeitpflege von über 65-jährigen Pflegebedürftigen beschäftigt, beschränkt sich zumeist auf den körperlichen und psychologischen Zustand der pflegebedürftigen Person als Einflussfaktor. Bisher wurde das regionale Angebot an stationärer Pflege nicht als Einflussfaktor untersucht. In dieser Studie untersuchen wir die Wahl der Pflegeform in Deutschland, wobei wir explizit das regionale Angebot an Pflegeheimplätzen als potenziellen Einflussfaktor in unser empirisches Modell einbeziehen. Darüber hinaus berücksichtigen wir in unserer Modellierung alle vier informellen sowie formellen Pflegeformen, die in Deutschland angeboten werden. Unsere Ergebnisse zeigen, dass die Entscheidung für stationäre Pflege signifikant mit dem regionalen Angebot an Pflegeheimplätzen korreliert, sofern für den körperlichen und psychologischen Zustand des Pflegebedürftigen und regionale Unterschiede kontrolliert wird.
    Keywords: informal care,formal care,choice of care,administrative data,nursing home supply
    JEL: C35 D12 I11
    Date: 2014
  29. By: Brosig-Koch, Jeannette; Kairies-Schwarz, Nadja; Kokot, Johanna
    Abstract: Most common physician payment schemes include some form of traditional capitation or fee-for-service payment. While health economics research often focuses on direct incentive effects of these payments, we demonstrate that the opportunity to sort into one's preferred payment scheme may also significantly affect medical treatment. Our study is based on an experiment testing individual sorting into fee-for-service and capitation payment under controlled laboratory conditions. A sequential design allows differentiating between sorting and incentive effects. We find a strong preference for fee-for-service payment, independent of subjects' prior experience with one of the two payment schemes. Our behavioral classification reveals that subjects who select into capitation deviate less from patient-optimal treatment than those who prefer fee-for-service payment. Moreover, comparing subjects' behavior before and after introducing the choice option, we find that subjects preferring fee-for-service become even less patient-oriented after this introduction. As a result, the opportunity to choose a payment scheme does not improve, but - if at all - worsens patient treatment in our experiment. Our findings stress the importance of acknowledging potential sorting and incentive effects in the analysis of physician payment schemes.
    Abstract: Die meisten der heutzutage verwendeten Arztvergütungen basieren auf der klassischen Einzelleistungsvergütung oder der Kopfpauschale. Während die gesundheitsökonomische Forschung häufig auf die direkten Anreizwirkungen dieser Vergütungssysteme fokussiert, wird hier gezeigt, dass auch die Möglichkeit, die eigene Vergütungsform frei zu wählen, die Behandlungsqualität signifikant beeinflussen kann. Die Studie basiert auf einem Experiment, in dem die Selektion in die Einzelleistungsvergütung und die Kopfpauschale unter kontrollierten Laborbedingungen getestet wird. Mit Hilfe eines sequentiellen Designs kann zwischen Anreiz- und Selektionseffekten differenziert werden. Zudem werden die beiden Vergütungsformen so gestaltet, dass sie identische Gewinnmöglichkeiten bieten. Die Ergebnisse offenbaren eine starke Präferenz für die Einzelleistungsvergütung - unabhängig von den vorherigen Erfahrungen der Teilnehmer mit den beiden Vergütungsformen. Die Analyse des Verhaltens vor der Einführung der Auswahlmöglichkeit zeigt, dass die Teilnehmer, die sich später in die Einzelleistungsvergütung selektieren, stärker von der patienten-optimalen Behandlung abweichen als die Teilnehmer, die sich später in die Kopfpauschale selektieren. Zudem nimmt bei den Teilnehmern, die die Einzelleistungsvergütung wählen, die Behandlungsqualität nach der Einführung der Auswahlmöglichkeit weiter ab. Im Ergebnis beobachten wir bei der Einführung einer Auswahlmöglichkeit zwischen Kopfpauschale und Einzelleistungsvergütung keine Verbesserung, sondern - wenn überhaupt - eine signifikante Verschlechterung der Behandlungsqualität. Die Befunde weisen darauf hin, dass bei der Beurteilung von Vergütungssystemen sowohl Anreizeffekte als auch potentielle Selektionseffekte zu berücksichtigen sind.
    Keywords: physician incentives,fee-for-service,capitation,payment choice,sorting effects,laboratory experiment
    JEL: C91 D84
    Date: 2014
  30. By: Augurzky, Boris; Bauer, Thomas K.; Reichert, Arndt R.; Schmidt, Christoph M.; Tauchmann, Harald
    Abstract: We complement the empirical evidence on the sustainability of weight loss achieved through cash rewards and, for the first time, rigorously examine the potential of cash rewards to prevent weight cycling. In a three period randomized controlled trial, about 700 obese persons were first assigned to two treatment groups, which were promised cash contingent on the achievement of an individually assigned target weight, and to a control group. Successful participants were subsequently allocated to two treatment groups offered cash rewards for confirming the previously achieved target weight and to a control group. This is the first experiment of this kind that finds effects of weight loss rewards up to 18 months after they were removed. Additional rewards only significantly improve the sustainability of weight loss while they are in place.
    Abstract: Die empirische Analyse untersucht zum einen die Nachhaltigkeit einer Gewichtsreduktion, die mittels Geldanreizen erzielt wurde, und zum anderen die Wirksamkeit von Geldanreizen zur Verhinderung des Jo-Jo-Effekts nach einer erfolgreichen Gewichtsreduktion. In einem drei-phasigen Feldexperiment wurden ca. 700 fettleibige Teilnehmer zunächst zufällig auf zwei Anreizgruppen und einer Kontrollgruppe verteilt. Unabhängig von der Gruppenzugehörigkeit sollten ein individuelles Gewichtsreduktionziel erreicht werden, wobei nur Mitglieder der Anreizgruppen eine Geldprämie für das Erreichen des Zieles erhalten konnten. Erfolgreiche Teilnehmer wurden danach erneut zufällig einer Kontrollgruppe und zwei Anreizgruppen zugewiesen, wobei das Halten des Zielgewichts nur für letztere durch eine Geldprämie inzentiviert wurde. Anders als in früheren Experimenten, können Effekt der Abnehmprämie selbst 18 Monate nach ihrem Auslaufen nachgewiesen werden. Monetäre Anreize zur Verhinderung des Jo-Jo-Effekt wirken hingegen nicht über ihr Auslaufen hinaus.
    Keywords: field experiment,weight cycling,sustainability,incentives
    JEL: I12 I18 D03 C93
    Date: 2014
  31. By: Kairies-Schwarz, Nadja; Kokot, Johanna; Vomhof, Markus; Wessling, Jens
    Abstract: Recent health policy reforms try to increase consumer choice. We use a laboratory experiment to analyze consumers' tastes in typical contract attributes of health insurances and to investigate their relationship with individual risk preferences. First, subjects make consecutive insurance choices varying in the number and types of contracts offered. Then, we elicit individual risk preferences according to Cumulative Prospect Theory. Applying a latent class model to the choice data, reveals five classes of consumers with considerable heterogeneity in tastes for contract attributes. From this, we infer distinct behavioral strategies for each class. The majority of subjects use minimax strategies focusing on contract attributes rather than evaluating probabilities in order to maximize expected payoffs. Moreover, we show that using these strategies helps consumers to choose contracts, which are in line with their individual risk preferences. Our results reveal valuable insights for policy makers of how to achieve efficient consumer choice.
    Abstract: Jüngste Gesundheitsreformen versuchen, Wahlmöglichkeiten für Konsumenten zu verbessern. Wir verwenden ein Laborexperiment, um die Präferenzen von Konsumenten für typische Vertragsattribute von Krankenversicherungen zu analysieren und um ihre Beziehung zu individuellen Risikopräferenzen zu untersuchen. Zuerst treffen Teilnehmer aufeinanderfolgende Versicherungsentscheidungen, die in der Anzahl und der Art der angebotenen Verträge variieren. Anschließend erheben wir individuelle Risikopräferenzen im Sinne der kumulativen Prospect Theory. Ein auf die Entscheidungsdaten angewandtes Latent Class Modell kann fünf Klassen von Konsumenten mit einer beachtlichen Heterogenität in Präferenzen für Vertragsattribute identifizieren. Davon ausgehend leiten wir spezifische Verhaltensstrategien für jede Klasse ab. Die Mehrheit der Teilnehmer wendet Minimax-Strategien an und konzentriert sich auf Vertragsattribute, anstatt Wahrscheinlichkeiten zu bewerten um die erwartenden Auszahlungen zu maximieren. Ferner zeigen wir, dass die Anwendung dieser Strategien Konsumenten hilft, Verträge zu wählen, die mit ihren individuellen Risikopräferenzen übereinstimmen. Unsere Ergebnisse liefern wertvolle Einsichten für politische Entscheidungsträger, wie sie effiziente Wahlmöglichkeiten für Konsumenten erreichen können.
    Keywords: health insurance,risk preferences,heterogeneity,heuristics,laboratory experiment,cumulative prospect theory
    JEL: C91 I13 D81
    Date: 2014
  32. By: Bünnings, Christian; Schmitz, Hendrik; Tauchmann, Harald; Ziebarth, Nicolas R.
    Abstract: This paper empirically assesses the relative role of health plan prices, service quality and optional benefits in the decision to choose a health plan. We link representative German SOEP panel data from 2007 to 2010 to (i) health plan service quality indicators, (ii) measures of voluntary benefit provision on top of federally mandated benefits, and (iii) health plan prices for almost all German health plans. Mixed logit models incorporate a total of 1,700 health plan choices with more than 50 choice sets for each individual. The findings suggest that, compared to prices, health plan service quality and supplemental benefits play a minor role in making a health plan choice.
    Abstract: Dieses Papier untersucht empirisch die Rollen von Beitrag, Servicequalität und freiwilligen Zusatzleistungen im Rahmen der Krankenkassenwahl. Dazu verknüpfen wir repräsentative Paneldaten des SOEP der Jahre 2007 bis 2010 mit kassenspezifischen Indikatoren für (i) die Servicequalität, (ii) das Angebot von freiwilligen Zusatzleistungen und (iii) den Beitrag von fast allen deutschen Krankenkassen. Die verwendeten mixed logit Modelle basieren auf 1 700 individuellen Entscheidungssituationen, welche jeweils mehr als 50 Krankenkassen zur Wahl beinhalten. Die Ergebnisse deuten an, dass Servicequalität und freiwillige Zusatzleistungen eine - im Vergleich zu Beiträgen - untergeordnete Rolle in der Wahl der Krankenkasse spielen.
    Keywords: service quality,non-essential benefits,prices,health plan switching,German sickness funds,SOEP
    JEL: D12 H51 I11 I13 I18
    Date: 2015
  33. By: Brosig-Koch, Jeannette; Hennig-Schmidt, Heike; Kairies-Schwarz, Nadja; Wiesen, Daniel
    Abstract: Mixed payment systems have become a prominent alternative to paying physicians through fee-for-service and capitation. While theory shows mixed payment systems to be superior, empirically, causal effects on physicians' behavior are not well understood when introducing mixed systems. We systematically analyze the influence of fee-for-service, capitation, and mixed payment systems on physicians' service provision. In a controlled laboratory setting, we implement an exogenous variation of the payment method. Participants, in the role of physicians, in the lab (N=213) choose quantities of medical services affecting patients' health outside the lab. Behavioral data reveal significant overprovision of medical services under fee-for-service and significant underprovision under capitation, though less than predicted when assuming profit-maximization. Introducing mixed payment systems significantly reduces deviations from patient-optimal treatment. Responses to incentive systems can be explained by a behavioral model capturing physician altruism. We find substantial heterogeneity in physician altruism. Our results hold for medical and non-medical students.
    Abstract: In den letzten Jahren wurden klassische Entlohnungssysteme für Ärzte wie Einzelleistungsvergütung oder Kopfpauschale häufig durch gemischte Vergütungen ersetzt. Aus theoretischer Sicht sind diese gemischten Vergütungen den klassischen Vergütungen überlegen. Empirisch sind die kausalen Effekte der Einführung von gemischten Vergütungen auf das Arztverhalten jedoch unklar. Im Mittelpunkt dieses Beitrags steht die systematische Analyse der Verhaltenswirkungen von Kopfpauschale, Einzelleistungsvergütung und gemischten Vergütungssystemen. Mit Hilfe kontrollierter Laborexperimente werden die Arztvergütungen exogen variiert und die Auswirkungen auf die Behandlung von Patienten getestet. Im Rahmen des Experiments müssen die Teilnehmer in der Rolle des Arztes (N=213) über die Menge an medizinischen Leistungen entscheiden, die die Gesundheit realer Patienten außerhalb des Labors beeinflusst. Die Ergebnisse zeigen eine signifikante Überbehandlung bei der Einzelleistungsvergütung und eine signifikante Unterbehandlung bei der Kopfpauschale, allerdings in geringerem Ausmaß als dies theoretisch bei reiner Gewinnmaximierung prognostiziert wird. Die Einführung gemischter Vergütungssysteme reduziert die beobachteten Abweichungen von der patientenoptimalen Behandlung. Die Verhaltenswirkungen lassen sich mit Hilfe eines Verhaltensmodells abbilden, in dem den Teilnehmern ein gewisser Grad an Altruismus unterstellt wird. Der beobachtete Grad an Altruismus variiert stark zwischen den Teilnehmern. Die Befunde hängen nicht vom medizinischen Hintergrund der Teilnehmer ab und gelten damit sowohl für angehende Ärzte als auch für Studenten anderer Fachrichtungen.
    Keywords: fee-for-service,capitation,mixed payment systems,physician altruism,laboratory experiment
    JEL: C91 I11
    Date: 2015
  34. By: Avdic, Daniel; Büyükdurmus, Tugba
    Abstract: We contribute to the literature on the determinants of socioeconomic health disparities by studying how the health behavior of adolescents may arise from the degree of communication between parent and child. Parent-child communication may function as a mediator between family background and subsequent poor health behavior, potentially reconciling previous mixed evidence on the relationship between child health and social status. Using data from a unique German child health survey we construct an index of parent-child communication quality by comparing responses to statements about the children's well-being from both children and their parents. Applying the constructed communication measure in a continuous treatment empirical framework, allowing for estimation of non-linear effects, our results show that improved parent-child communication monotonously reduces the smoking prevalence of adolescents by as much as 70%, irrespective of social background. More complex relationships are found for risky alcohol consumption and abnormal body weight.
    Abstract: Unser Beitrag zur Literatur besteht in einer tiefergehenden Analyse gesundheitlicher Disparitäten im Jugendalter, die mit sozioökonomischen Determinanten in Zusammenhang stehen. Wir gehen der Frage nach, ob und inwiefern die Eltern-Kind-Kommunikation eine zwischengeschaltete Funktion in der Abhängigkeit von sozioökonomischem Status der Familie und Gesundheitsverhalten der Kinder im Jugendalter einnimmt. Die Hypothese, dass die Kommunikation als eine Art Mediator fungiert, resultiert aus den teils gegensätzlichen Befunden empirischer Studien zu diesem Zusammenhang. Unter Verwendung eines einzigartigen Datensatzes einer deutschen Kindergesundheitsstudie (KIGGS) erstellen wir einen Index, der die Qualität der Eltern-Kind-Kommunikation erfasst. Dieser wird durch den Vergleich der Aussagen der Kinder über ihr Wohlbefinden mit denen ihrer Eltern quantifiziert. Unter Verwendung einer empirischen Methode, die den kontinuierlichen Charakter des Kommunikationsindex berücksichtigt und die Schätzung nicht-linearer Zusammenhänge erlaubt, zeigen unsere Ergebnisse, dass eine bessere Eltern-Kind-Kommunikation unabhängig von der sozialen Herkunft mit einer monoton abnehmenden Prävalenz des Rauchens Jugendlicher einhergeht. Während die Beziehung zwischen der Kommunikationsqualität und dem Tabakkonsum eindeutig negativ ist, sind die Zusammenhänge zum riskanten Alkoholkonsum und zu Gewichtsproblemen Jugendlicher weitaus komplexer.
    Keywords: child health,health behavior,communication,intergenerational transmission,socioeconomic inequality,continuous treatment effect
    JEL: C31 D83 I12 I14 J13
    Date: 2015
  35. By: Guglielmo Maria Caporale; Juncal Cunado; Luis A. Gil-Alana; Rangan Gupta
    Abstract: This study examines the relationship between healthcare expenditure and disposable income in the 50 US states over the period 1966-2009 using fractional integration and cointegration techniques. The degree of integration and nonlinearity of both series are found to vary considerably across states, whilst the fractional cointegration analysis suggests that a long-run relationship exists between them in only 11 out of the 50 US states. The estimated long-run income elasticity of healthcare expenditure suggests that health care is a luxury good in these states. By contrast, the short-run elasticity obtained from the regressions in first differences is in the range (0,1) for most US states, which suggests that health care is a necessity good instead. The implications of these results for health policy are also discussed.
    Keywords: Healthcare expenditure; income elasticity; US states; fractional integration; fractional cointegration
    JEL: C22 C32 H51 I18
    Date: 2015
  36. By: Laura Rossouw
    Abstract: Researchers often rely on household survey data to investigate health disparities and the incidence and prevalence of illness. These self-reported health measures are often biased due to information asymmetry or differences in reference groups. Using the World Health Organization study on global ageing and adult health, I find that the poor use a different reporting scale from the more affluent, leading to overestimation of their health status. This is tested by using the relatively novel anchoring vignettes approach and applying the hierarchical ordered probit model. Underestimation by the poor of their ill health could mean that South Africa’s high levels of socioeconomic health inequalities are greater than realized.
    Keywords: Equality and inequality, Health care, Public health
    Date: 2015
  37. By: Breining, Sanni (Aarhus University); Daysal, N. Meltem (University of Southern Denmark); Simonsen, Marianne (Aarhus University); Trandafir, Mircea (University of Southern Denmark)
    Abstract: We investigate the spillover effects of early-life medical treatments on the siblings of treated children. We use a regression discontinuity design that exploits changes in medical treatments across the very low birth weight (VLBW) cutoff. Using administrative data from Denmark, we first confirm the findings in the previous literature that children who are slightly below the VLBW cutoff have better short- and long-term health, and higher math test scores in 9th grade. We next investigate spillover effects on siblings and find no evidence of an impact on their health outcomes. However, we find substantial positive spillovers on all our measures of academic achievement. Our estimates suggest that siblings of focal children who were slightly below the VLBW cutoff have higher 9th grade language and math test scores, as well as higher probability of enrolling in a high school by age 19. Our results suggest that improved interactions within the family may be an important pathway behind the observed spillover effects.
    Keywords: medical care, birth, children, schooling, spillovers
    JEL: I11 I12 I18 I21 J13
    Date: 2015–05
  38. By: Fortin, Bernard (Université Laval); Yazbeck, Myra (University of Queensland)
    Abstract: This paper aims at opening the black box of peer effects in adolescent weight gain. Using Add Health data on secondary schools in the U.S., we investigate whether these partly flow through the eating habits channel. Adolescents are assumed to interact through a friendship social network. We propose a two-equation model. The first equation provides a social interaction model of fast food consumption. To estimate this equation we use a quasi maximum likelihood approach that allows us to control for common environment at the network level and to solve the simultaneity (reflection) problem. Our second equation is a panel dynamic weight production function relating an individual's Body Mass Index z-score (zBMI) to his fast food consumption and his lagged zBMI, and allowing for irregular intervals in the data. Results show that there are positive but small peer effects in fast food consumption among adolescents belonging to a same friendship school network. Based on our preferred specification, the estimated social multiplier is 1.15. Our results also suggest that, in the long run, an extra day of weekly fast food restaurant visits increases zBMI by 4.45% when ignoring peer effects and by 5.11%, when they are taken into account.
    Keywords: fast food, social interactions, peer effects, overweight, obesity, spatial models
    JEL: C31 I10 I12
    Date: 2015–05
  39. By: Jin, Lawrence (Cornell University); Ziebarth, Nicolas R. (Cornell University)
    Abstract: This paper comprehensively studies the health effects of Daylight Saving Time (DST) regulation. Relying on up to 3.4 million BRFSS respondents from the US and the universe of 160 million hospital admissions from Germany over one decade, we do not find much evidence that population health significantly decreases when clocks are set forth by one hour in spring. However, when clocks are set back by one hour in fall, effectively extending sleep duration for the sleep deprived by one hour, population health slightly improves for about four days. The most likely explanation for the asymmetric effects are behavioral adjustments by marginal people in spring.
    Keywords: Daylight Saving Time (DST), BRFSS, hospital admissions, sleep deprivation, Germany, US
    JEL: H41 I18 I31
    Date: 2015–05
  40. By: Aleksandar Vasilev (American University in Bulgaria)
    Abstract: This paper aims to shed light on the importance of health considerations for business cycle uctuations and the effect of health status on labor productivity and availability of labor input for productive use. To this end, Grossman's (2000) partial-equilibrium framework with endogenous health is incorporated in an otherwise standard Real-Business-Cycle (RBC) model. Health status in this setup is modelled as a utility-enhancing, intangible, and non-transferrable capital stock, which depreciates over time. The household can improve their health ("produce health") through investment using a health-recovery technology. The main results are: (i) overall, the model compares well vis-a-vis data; (ii) the behavior of the price of healthcare is adequately approximated by the shadow price of health in the model; (iii) the model-generated health variable exhibits moderate- to high correlation with a large number of empirical health indicators.
    Keywords: real business cycles, health status, health investment
    JEL: E32 E37 I11 I13
    Date: 2015–02

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