Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.copayments, ambulatory care, difference-in-difference, count data, zero-inflated-model

Einkommen, Sparen und intrafamiliale Transfers von älteren Menschen

Die jüngsten Reformen der Bundesregierung zur Konsolidierung der finanziellen Lage der gesetzlichen Rentenversicherung (GRV) belasten vermehrt die heutige Rentnergeneration. Eine Beschreibung der Lebenslage und Einkommenssituation von älteren Menschen gibt Hinweise, ob diese Maßnahmen zu sozialpolitischen Verwerfungen führen können. Neueste Ergebnisse auf Basis des vom DIW Berlin in Zusammenarbeit mit Infratest Sozialforschung erhobenen Sozio-oekonomischen Panels (SOEP) zeigen, dass die Einkommensposition alter Menschen nicht viel unter dem Durchschnitt aller Haushalte liegt und die Mehrzahl finanziell sogar deutlich besser gestellt ist als Familien mit Kindern. Seit Mitte der 80er Jahre konnten die Alten insgesamt ihre Einkommensposition zudem nachhaltig verbessern. In diesem Zusammenhang wird auch der Frage nachgegangen, wie die Spar- und Transferneigung von Alten ist. Da die Konsumneigung mit dem Alter tendenziell abnimmt, sparen ältere Menschen im Vergleich zur Gesamtbevölkerung überdurchschnittlich viel. Mehr als zwei Drittel der Alten sparen oder leisten Transfers an Enkel und Kinder

Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.copayments, ambulatory care, difference-in-difference, count data, zeroinflated- model

Private net worth in Eastern and Western Germany only converging slowly

Very nearly 25 years after the fall of the Berlin Wall, households in eastern Germany have an average net worth of 67,400 euros which is less than half that of their counterparts in western Germany with an average net worth of 153,200 euros. In both parts of the country, real estate ownership is quantitatively the most important asset type. Although the share of owner-occupiers has increased significantly in both regions since 1990, only one-third of all households in eastern Germany are owner occupied whereas the corresponding share in the west is almost half. Further, the market value of the real estate owned in eastern Germany is only half of that in the west. There has, however, been a significant convergence both in terms of average living space and property furnishings since the fall of the Wall

Is There a "Dead-Anyway" Effect in Willingness to Pay for Risk Reduction?

In einem neueren Beitrag diskutieren Pratt and Zeckhauser (JPE, 1996), welches Maß der marginalen Zahlungsbereitschaft (WTP) von Individuen für die Reduktion ihrer Sterbewahrscheinlichkeit bei öffentlichen Entscheidungen über gefahrenerhebliche Projekte verwendet werden sollte. Sie schlagen vor, die gemessene WTP um den so genannten "Dead-anyway"-Effekt zu berichtigen, der besagt, dass die WTP mit dem Ausgangswert des Risikos zunimmt, dem das befragte Individuum ausgesetzt ist. Dieser Effekt beruht allerdings auf der Abwesenheit vollkommener Märkte für bedingte Güter. Wir diskutieren zunächst die theoretischen Grundlagen des "Dead-anyway"-Effekts und schlagen dann einen neuen empirischen Test mittels der Beziehung zwischen Vermögen, Sterberisiko und Lebenszufriedenheit vor. Eine Anwendung des Tests an Hand zweier Sätze von Umfragedaten aus Deutschland und Australien ergibt keine Bestätigung für den von Pratt und Zeckhauser behaupteten Effekt. In a recent paper, Pratt and Zeckhauser (JPE, 1996) discuss the measure of individuals' willingness to pay (WTP) for the reduction of risks to their lives which should be used for public decisions on risk-reducing projects. They suggest to correct observed WTP for the "dead-anyway" effect, which says that WTP increases with the level of risk to which the individual is exposed - an effect which is due to the imperfection of contingent-claims markets. We first discuss the theoretical foundations of the asserted effect and then propose a new empirical test based on the relationship between wealth, life satisfaction and exposure to risk of dying. Application of the test using two sets of survey data from Germany and Australia.yields no support for the asserted dead-anyway effect.value of statistical life, mortality risk, contingent-claims markets

Copayments for Ambulatory Care in Germany: A Natural Experiment Using a Difference-in-Difference Approach

In response to increasing health expenditures and a high number of physician visits, the German government introduced a copayment for ambulatory care in 2004 for individuals with statutory health insurance (SHI). Because persons with private insurance were exempt from the copayments, this health care reform can be regarded as a natural experiment. We used a difference-in-difference approach to examine whether the new copayment effectively reduced the overall demand for physician visits and to explore whether it acted as a deterrent to vulnerable groups, such as those with low income or chronic conditions. We found that there was no significant reduction in the number of physician visits among SHI members compared to our control group. At the same time, we did not observe a deterrent effect among vulnerable individuals. Thus, the copayment has failed to reduce the demand for physician visits. It is likely that this result is due to the design of the copayment scheme, as the copayment is low and is paid only for the first physician visit per quarter.Copayments, ambulatory care, difference-in-difference, count data, zeroinflated-model, SOEP

The Personal Distribution of Income and Imputed Rent: A Cross-National Comparison for the UK, West Germany and the USA

This article deals with income advantages derived from owner occupied housing (Imputed Rent, IR) and their impact on the personal income distribution. Following a brief description of different methods with which to calculate IR in household surveys, we conduct a cross-national comparative study based on micro-data from the British Household Panel Study (BHPS), the German Socio- Economic Panel (SOEP), and the US Panel Study of Income Dynamics (PSID). We find distinct differences between the Anglo-Saxon countries and Germany in terms of prevalence and extent of IR as well as in terms of the impact on the overall income distribution. In all three countries, however, using IR in measures of old age provision improves the quality of economic well-being assessment for the elderly.Personal Income Distribution, Owner Occupied Housing, Imputed Rent, Old Age Provision

In Vino Pecunia?: The Association between Beverage-Specific Drinking Behavior and Wages

The positive association between moderate alcohol consumption and wages is well documented in the economic literature. Positive health effects as well as networking mechanisms serve as explanations for the "alcohol-income puzzle." Using individual-based microdata from the GSOEP for 2006, we confirm that this relationship exists for Germany as well. More importantly, we shed light on the alcohol-income puzzle by analyzing, for the first time, the association between beverage-specific drinking behavior and wages. In our analysis, we disentangle the general wage effect of drinking into diverse effects for different types of drinkers. Mincerian estimates reveal significant and positive relationships between wine drinkers and wages as well as between beverage-unspecific drinkers and wages. We are unable to detect endogeneity problems with the drinking variables, which speaks in favor of OLS regressions. When splitting the sample into age groups, the "wine gain" disappears for employees under the age of 35 and increases in size and significance for higher age groups. We also find a "beer gain" for residents of rural areas and a "cocktail gain" for residents of urban areas. Several explanations for our empirical results are discussed in view of the likelihood that the alcohol-income puzzle is a multicausal phenomenon."alcohol-income puzzle," beverage-specific drinking behavior, wages, wine

Private Vermögen in Ost- und Westdeutschland gleichen sich nur langsam an

Auch rund 25 Jahre nach dem Mauerfall verfügen private Haushalte in Ostdeutschland mit im Durchschnitt 67 400 Euro über nicht einmal halb so hohe Vermögen wie die in Westdeutschland, wo es rund 153 200 Euro sind. In beiden Landesteilen ist der Immobilienbesitz die quantitativ wichtigste Vermögensform. Der Anteil der Eigentümerhaushalte hat zwar in beiden Landesteilen seit 1990 deutlich zugenommen, in Ostdeutschland sind aber nur rund ein Drittel aller Haushalte selbstnutzende Eigentümer, wohingegen im Westen knapp die Hälfte aller Haushalte eine selbstgenutzte Immobilie besitzt. Auch der Verkehrswert des Immobilienbesitzes fällt in Ostdeutschland nur halb so hoch aus wie im Westen. Sowohl hinsichtlich der durchschnittlichen Wohnfläche als auch bezüglich der Ausstattung der Immobilien erfolgtehingegen seit dem Mauerfall eine deutliche Angleichung.Very nearly 25 years after the fall of the Wall, households in eastern Germany have average assets of 67,400 euros which is less than half of their counterparts in western Germany with average assets of 153,200 euros. In both parts of the country, real estate ownership is quantitatively the most important asset type. Although the share of owner-occupiers has increased significantly in both regions since 1990, only one-third of all households in eastern Germany are owner occupied whereas the corresponding proportion in the west is almost half. Further, the market value of the real estate owned in eastern Germany is only half of that in the west. There has, however, been a significant convergence both in terms of average living space and property furnishings since the fall of the Wall

Missing Income Data in the German SOEP: Incidence, Imputation and its Impact on the Income Distribution

This paper deals with the question of selectivity of missing data on income questions in large panel surveys due to item-non-response and with imputation as one alternative strategy to cope with this issue. In contrast to cross-section surveys, the imputation of missing values in panel data can profit from longitudinal information which is available for the very same observation units from other points in time. The "row-and-column imputation procedure" developed by Little & Su (1989) considers longitudinal as well as cross-sectional information in the imputation process. This procedure is applied to the German Socio-Economic Panel study (SOEP) when deriving annual income variables, complemented by purely cross-sectional techniques. Based on the SOEP, our empirical work starts with a description of the overall incidence of imputation and its relevance given by imputed income as a percentage share of the total income mass: e.g. while 21 % of all observations have at least one missing income component of their pre-tax post-transfer income, 9 % of the overall income mass is imputed. However, this picture varies considerably for more recent sub-samples of the panel survey. Secondly, we analyze the respective impact of imputation on the personal distribution of income as well as on results of income mobility. When comparing income inequality measures based only on truly observed information to those derived from all (i.e., observed and imputed) observations, we find an increase in inequality due to imputation and this effect appears to be relevant in both tails of the distribution, although somewhat more prominent among higher incomes. Longitudinal analyses show firstly a positive correlation of item-non-response on income data over time, but also provide evidence of item-non-response as being a predictor of subsequent unit-non-response. Applying various income mobility indicators there is a robust picture about income mobility being understated using truly observed information only. Finally, multivariate models show that survey-related factors (number of interviews, interview mode) as well as indicators for variability in income receipt (due to increased complexity of household structure and income composition) are significantly correlated with item-non-response. In conclusion, our empirical results based on the German SOEP indicate the selectivity of item-non-response on income questions in social surveys and push the necessity for adequate imputation.Item-Non-Response, Imputation, Income Inequality