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

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

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

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

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

Accounting for Imputed and Capital Income Flows in Income Inequality Analyses

Using representative and consistent microdata from the German Socio-Economic Panel Study (SOEP) from 1985-2007, we illustrate that capital income (CI = return on financial investments) and imputed rent (IR = return on investments in owner-occupied housing) have become increasingly important sources of economic inequality in Germany over the last two decades. Whereas the operationalization of CI in this paper is based on monetary returns on financial investments only, our definition of IR follows a regulation by the European Commission, (EC) which is currently being used to harmonize income measurement for the European Statistics on Income and Living Conditions (EU-SILC) in Europe. While both of these components represent some kind of return on alternative private investments, our results indicate that they do not coincide in their impacts on income inequality and poverty. In line with the literature, net IR as defined according to the EC regulation tends to exert a dampening effect on inequality and relative poverty, very much driven by the increasing share of outright ownership among the elderly. On the other hand, inequality is boosted by CI especially when looking at the upper tail of the income distribution. As the German public pension scheme gradually loses its ability to maintain people's living standards into retirement, we find these effects to increase over time. The analyses presented here, exemplified for Germany, make a clear case for the joint consideration of all components of private investment income for the purpose of welfare analysis, be they of a monetary or non-monetary nature. This appears to be relevant in at least three dimensions of comparative research: (1) across time; (2) across space, regions, welfare regimes; (3) across the individual life course, thus analyzing the impact of investment income on intrapersonal mobility patterns.income inequality, decomposition, capital income, imputed rent, SOEP

Item Non-response and Imputation of Annual Labor Income in Panel Surveys from a Cross-National Perspective

Using data on annual individual labor income from three representative panel datasets (German SOEP, British BHPS, Australian HILDA) we investigate a) the selectivity of item non-response (INR) and b) the impact of imputation as a prominent post-survey means to cope with this type of measurement error on prototypical analyses (earnings inequality, mobility and wage regressions) in a cross-national setting. Given the considerable variation of INR across surveys as well as the varying degree of selectivity build into the missing process, there is substantive and methodological interest in an improved harmonization of (income) data production as well as of imputation strategies across surveys. All three panels make use of longitudinal information in their respective imputation procedures, however, there are marked differences in the implementation. Firstly, although the probability of INR is quantitatively similar across countries, our empirical investigation identifies cross-country differences with respect to the factors driving INR: survey-related aspects as well as indicators accounting for variability and complexity of labor income composition appear to be relevant. Secondly, longitudinal analyses yield a positive correlation of INR on labor income data over time and provide evidence of INR being a pre-dictor of subsequent unit-non-response, thus supporting the "cooperation continuum" hy-pothesis in all three panels. Thirdly, applying various mobility indicators there is a robust picture about earnings mobility being significantly understated using information from completely observed cases only. Finally, regression results for wage equations based on observed ("complete case analysis") vs. all cases and controlling for imputation status, indicate that individuals with imputed incomes, ceteris paribus, earn significantly above average in SOEP and HILDA, while this relationship is negative using BHPS data. However, once applying the very same imputation procedure used for HILDA and SOEP, namely the "row-and-column-imputation" approach suggested by Little & Su (1989), also to BHPS-data, this result is reversed, i.e., individuals in the BHPS whose income has been imputed earn above average as well. In our view, the reduction in cross-national variation resulting from sensitivity to the choice of imputation approaches underscores the importance of investing more in the improved cross-national harmonization of imputation techniques.Item non-response, imputation, income inequality, income mobility, panel data, SOEP, BHPS, HILDA

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