Explaining Differentials in Subsidy Levels Among Hospital Ownership Types in Germany

German hospitals receive subsidies for investment costs by federal states. Theoretically, these subsidies have to cover the whole investment volume, but in fact only 50%-60% are covered. Balance sheet data show that public hospitals exhibit higher levels of subsidies compared to for-profit hospitals. In this study, I examine the sources of this disparity by decomposing the differential in a so-called facilitation ratio, i.e. the ratio of subsidies to tangible fixed assets, revealing to which extent assets are funded by subsidies. The question of interest is, whether the differential can be attributed to observable hospital-specific and federal state-specific characteristics or unobservable factors.Krankenhäuser in Deutschland erhalten gemäß dem Krankenhausfinanzierungsgesetz (KHG) Investitionsfördermittel von den Bundesländern. In der Theorie müssen die Fördermittel der Bundesländer das gesamte Investitionsvolumen der Kliniken decken, allerdings werden in der Praxis nur 50 bis 60 Prozent der Investitionen durch diese Investitionssubventionen gedeckt. Auswertungen von Bilanzdaten zeigen, dass Kliniken in öffentlich-rechtlicher Trägerschaft ein deutlich höheres Niveau an Investitionssubventionen aufweisen als Klinken in freigemeinnütziger sowie privater Trägerschaft. In dieser Studie werden die Ursachen dieser trägerspezifischen Differenzen in den Subventionsniveaus untersucht. Da die Investitionssubventionen an das Sachanlagevermögen gebunden sind, wird als Zielgröße der Quotient aus Subventionen und Sachanlagevermögen, eine sogenannte Förderquote, herangezogen. Die Förderquote zeigt an, inwieweit das Sachanlagevermögen subventioniert wird. Insbesondere wird untersucht, ob die trägerspezifischen Abweichungen in den Förderquoten auf Unterschiede in den Krankenhauscharakteristika, auf Unterschiede zwischen den Bundesländern oder auf unbeobachtbare Einflüsse zurückgeführt werden können

Is There a Future for Small Hospitals in Germany?

We analyse the financial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of financial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We find that, on average, small hospitals have more financial difficulties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profit hospitals tend to perform very well, small public hospitals face considerable financial problems. Apart from ownership, we find that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better financial performance.Wir untersuchen die wirtschaftliche Leistung von kleinen Krankenhäusern (weniger als 200 Betten) basierend auf Jahresabschlussdaten von insgesamt etwa 1.000 deutschen Krankenhäusern für das Jahr 2007. Dabei messen wir die wirtschaftliche Leistung durch das EBITDA (earnings before interest, tax, depreciation, and amortization) und die Insolvenzwahrscheinlichkeit. Im Durchschnitt sind kleine Krankenhäuser in einer schlechteren wirtschaftlichen Verfassung als größere. Es zeigt sich allerdings, dass es deutliche Unterschiede zwischen kleinen Krankenhäusern gibt. Während kleine private Krankenhäuser sehr gut abschneiden, ist die Lage bei denen in öffentlich-rechtlicher Trägerschaft im Durchschnitt deutlich schlechter. Zudem gehen eine höhere Spezialisierung, weniger öffentliche Fördermittel und ein höherer Anteil an pauschalen Fördermitteln (im Vergleich zu Einzelfördermaßnahmen) mit einer besseren Wirtschaftlichkeit einher

Does Higher Cost Inefficiency Imply Higher Profit Inefficiency? Evidence on Inefficiency and Ownership of German Hospitals

This paper investigates cost and profit efficiency of German hospitals. More specifically, it deals with the question how hospital efficiency varies with ownership, patient structure,and other exogenous factors, which are neither inputs nor outputs of the production process. We conduct a Stochastic Frontier Analysis (SFA) on a multifaceted administrative German dataset combined with the balance sheets of 374 hospitals for the years 2002 to 2005.The results indicate that private (for-profit) and (private) non-profit hospitals are on average less cost efficient but more profit efficient than publicly owned hospitals

The Effect of Self-Assessed Job Security on the Demand for Medical Rehab

The interdependence of labor market conditions and the demand for health care has been addressed by several theoretical and empirical analyses. We contribute to the debate by empirically examining the effect of a decrease in self-perceived job security on health care utilization. That is, employees at risk of losing their job might postpone or even try not to use non-acute rehab measures in order to reduce their individual risk of being laid off by avoiding absenteeism and signaling good health. We use individual-level data from the German Socioeconomic Panel for the years 2003, 2004, and 2006. The identification strategy rests on an instrumental variable approach where the county unemployment rate and its relative change compared to the previous year serve as instruments for the employees' self-assessed risk of losing their jobs. Contrary to the hypothesis, we have evidence for job insecurity increasing the demand for medical rehab. This finding is robust to various model variants

The Impact of Private Versus Social Health Insurance on Offered Waiting Times in German Acute Care Hospitals

This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further,we find that hospitals offering private insurees shorter waiting times as compared to SHI holders have a significantly better financial performance than those abstaining from or with less discrimination

Are German patients burdened by the practice charge for physician visits ('Praxisgebuehr')? A cross sectional analysis of socio-economic and health related factors

<p>Abstract</p> <p>Background</p> <p>In 2004, a practice charge for physician visits ('Praxisgebuehr') was implemented in the German health care system, mainly in order to reduce expenditures of sickness funds by reducing outpatient physician visits. In the statutory sickness funds, all adults now have to pay € 10 at their first physician visit in each 3 month period, except for vaccinations and preventive services. This study looks at the effect of this new patient fee on delaying or avoiding physician visits, with a special emphasis on different income groups.</p> <p>Methods</p> <p>Six representative surveys (conducted between 2004 and 2006) of the Bertelsmann Healthcare Monitor were analysed, comprising 7,769 women and men aged 18 to 79 years. The analyses are based on stratified analyses and logistic regression models, including a focus on the subgroup having a chronic disease.</p> <p>Results</p> <p>Two results can be highlighted. First, avoiding or delaying a physician visit due to this fee is seen most often among younger and healthier adults. Second, those in the lowest income group are much more affected in this way than the better of. The multivariate analysis in the subgroup of respondents having a chronic disease shows, for example, that this reaction is reported 2.45 times more often in the lowest income group than in the highest income group (95% CI: 1.90–3.15).</p> <p>Conclusion</p> <p>The analyses indicate that the effects of the practice charge differ by socio-economic group. It would be important to assess these effects in more detail, especially the effects on health care quality and health outcomes. It can be assumed, however, that avoiding or delaying physician visits jeopardizes both, and that health inequalities are increasing due to the practice charge.</p

Calculation of Direct Antiretroviral Treatment Costs and Potential Cost Savings by Using Generics in the German HIV ClinSurv Cohort

BACKGROUND/AIM OF THE STUDY: The study aimed to determine the cost impacts of antiretroviral drugs by analysing a long-term follow-up of direct costs for combined antiretroviral therapy, cART, -regimens in the nationwide long-term observational multi-centre German HIV ClinSurv Cohort. The second aim was to develop potential cost saving strategies by modelling different treatment scenarios. Antiretroviral regimens (ART) from 10,190 HIV-infected patients from 11 participating ClinSurv study centres have been investigated since 1996. Biannual data cART-initiation, cART-changes, surrogate markers, clinical events and the Centre of Disease Control- (CDC)-stage of HIV disease are reported. Treatment duration was calculated on a daily basis via the documented dates for the beginning and end of each antiretroviral drug treatment. Prices were calculated for each individual regimen based on actual office sales prices of the branded pharmaceuticals distributed by the license holder including German taxes. During the 13-year follow-up period, 21,387,427 treatment days were covered. Cumulative direct costs for antiretroviral drugs of €812,877,356 were determined according to an average of €42.08 per day (€7.52 to € 217.70). Since cART is widely used in Germany, the costs for an entire regimen increased by 13.5%. Regimens are more expensive in the advanced stages of HIV disease. The potential for cost savings was calculated using non-nucleotide-reverse-transcriptase-inhibitor, NNRTI, more frequently instead of ritonavir-boosted protease inhibitor, PI/r, in first line therapy. This calculation revealed cumulative savings of 10.9% to 19.8% of daily treatment costs (50% and 90% substitution of PI/r, respectively). Substituting certain branded drugs by generic drugs showed potential cost savings of between 1.6% and 31.8%. Analysis of the data of this nationwide study reflects disease-specific health services research and will give insights into the cost impacts of antiretroviral therapy, and might allow a more rational allocation of resources within the German health care system

Evaluating Rural Electrification Projects - Methodological Approaches

In recent years, the international community has expanded efforts in programme evaluation to improve the accountability of development projects. This paper presents approaches to implementing state-of-the-art evaluations in rural electrification projects, taking into account specific challenges that researchers face in such interventions. Furthermore, it suggests a particular approach to assess impacts before an intervention is implemented by surveying the yet non-electrified target region of the project and, in addition, an already electrified region. Besides delivering robust evidence on impacts, results from such ex-ante evaluations provide insights for the project design, thereby reducing the gap between evaluation researchers and practitioners

Psychosocial work load and stress in the geriatric care

<p>Abstract</p> <p>Background</p> <p>Due to the decrease in informal care by family members and the demographic development, the importance of professional geriatric care will rise considerably. Aim of this study was to investigate the psychosocial workplace situation for employees in this profession.</p> <p>Methods</p> <p>The German version of the COPSOQ (Copenhagen Psychosocial Questionnaire) was used for the assessment of psychosocial factors at work. The instrument includes 22 scales and 3 single items concerning demands, control, stress, support, and strain.</p> <p>Results between two study groups of geriatric care were compared to each other as well as to employees in general hospital care and a general population mean (COPSOQ database).</p> <p>Statistical analysis included t-tests, ANOVA and multiple comparisons of means. Statistical significance (p < 0.01, two-tailed) and a difference of at least 5 points in mean values were defined as the relevant threshold.</p> <p>Results</p> <p>In total 889 respondents from 36 institutions took part in the study. 412 worked in Home Care (HC), 313 in Geriatric Nursing Homes (GNH), 164 in other professions (e.g. administration).</p> <p>Comparison between HC and GNH showed more favourable values for the first group for the most scales, e.g. lower quantitative and emotional demands and less work-privacy conflict, better possibilities for development etc. Compared to external values from the German COPSOQ database for general hospital care (N = 1.195) and the total mean across all professions, COPSOQ-total (N = 11.168), the results are again positive for HC workers on most of the scales concerning demands and social support. The only negative finding is the very low amount of social relations at work due to the obligation to work alone most of the time. Employees in GNH rate predictability, quality of leadership and feedback higher when compared to general hospital care and show some further favourable mean values compared to the COPSOQ mean value for all professions. A disadvantage for GNH is the high rating for job insecurity.</p> <p>A supplementary subgroup analysis showed that the degree of negative evaluation of psychosocial factors concerning demands was related to the amount of working hours per week and the number of on-call duties.</p> <p>Conclusions</p> <p>Compared to employees in general hospital care and the COPSOQ overall mean value across all professions, geriatric care employees and especially home care workers evaluate their psychosocial working situation more positive for most aspects. However, this seems partly due to the very high proportion of part-time workers. Critical results for the two study groups are the relatively high job insecurity in nursing homes and the lack of social relations for the HCrs.</p