Do Optional Deductibles Reduce the Number of Doctor Visits?: Empirical Evidence with German Data

Deductibles in health insurance are often regarded as a means to contain health care costs when individuals exhibit moral hazard. However, in the absence of moral hazard, voluntarily chosen deductibles may instead lead to self-selection into different insurance contracts. We use a set of new variables in the German Socioeconomic Panel for the years 2002, 2004, and 2006 that measure individual health more accurately and include risk-attitudes towards health in order to determine the price elasticity of demand for health care. A latent class approach that takes into account the panel structure of the data reveals that the effect of deductibles on the number of doctor visits is negligible. Private add-on insurance increases the number of doctor visits. However, altogether the effects of the insurance state on the demand for doctor visits are small in magnitude.Health insurance, deductibles, add-on insurance, count data, latent class panel model

Do Optional Deductibles Reduce the Number of Doctor Visits? – Empirical Evidence with German Data

Deductibles in health insurance are often regarded as a means to contain health care costs when individuals exhibit moral hazard. However, in the absence of moral hazard, voluntarily chosen deductibles may instead lead to self-selection into different insurance contracts.We use a set of new variables in the German Socioeconomic Panel for the years 2002, 2004, and 2006 that measure individual health more accurately and include risk-attitudes towards health in order to determine the price elasticity of demand for health care.A latent class approach that takes into account the panel structure of the data reveals that the effect of deductibles on the number of doctor visits is negligible. Private add-on insurance increases the number of doctor visits.However, altogether the effects of the insurance state on the demand for doctor visits are small in magnitude.Health insurance, deductibles, add-on insurance, count data, latent class panel model

Benefit-Entitlement Effects and the Duration of Unemployment: An Ex-ante Evaluation of Recent Labour Market Reforms in Germany

Abstract: We analyse benefit-entitlement effects and the likely impact of the recent reform of the unemployment compensation system on the duration of unemployment in Germany on the basis of a flexible discrete-time hazard rate model estimated on pre-reform data from the German Socioeconomic Panel (SOEP). We find (i) relatively strong benefit-entitlement effects for the unemployed who are eligible to means-tested unemployment assistance after the exhaustion of unemployment benefit, but not for those without such entitlement; (ii) non-monotonic benefit-entitlement effects on hazard rates with pronounce spikes around the month of benefit-exhaustion, and (iii) relatively small marginal effects of the amount of unemployment compensation on the duration of unemployment. Our simulation results show that the recent labour market reform is unlikely to have a major impact on the average duration of unemployment in the population as a whole, but will significantly reduce the level of long-term unemployment among older workers.unemployment duration, unemployment insurance, benefit-entitlement effects, German labour market reforms, ex-ante evaluation, hazard rate model

Broke, Ill, and Obese: The Effect of Household Debt on Health

We analyze the effect of household indebtedness on different health outcomes using data from the German Socio-Economic Panel from 1999–2009. To establish a causal effect, we rely on (a) fixed-eff ects methods, (b) a subsample of constantly employed individuals, and (c) lagged debt variables to rule out problems of reverse causality. We apply different measures of household indebtedness, such as the percentage shares of household income spent on consumer credit and home loan repayments (which indicate the severity of household indebtedness) and a binary variable of relative overindebtedness (which indicates a precarious debt situation). We find all debt measures to be strongly correlated with health satisfaction, mental health, and obesity. Controlling for unobserved heterogeneity and reversed causality we find evidence that household debt also causally deteriorates physical and mental health. However, there is no causal effect on being obese.Debt; health satisfaction; mental health; obesity; fixed-effects

Broke, Ill, and Obese: The Effect of Household Debt on Health

We analyze the effect of household indebtedness on different health outcomes using data from the German Socio-Economic Panel from 1999-2009. To establish a causal effect, we rely on (a) fixed-effects methods, (b) a subsample of constantly employed individuals, and (c) lagged debt variables to rule out problems of reverse causality. We apply different measures of household indebtedness, such as the percentage shares of household income spent on consumer credit and home loan repayments (which indicate the severity of household indebtedness) and a binary variable of relative overindebtedness (which indicates a precarious debt situation). We find all debt measures to be strongly correlated with health satisfaction, mental health, and obesity. Controlling for unobserved heterogeneity and reversed causality we find evidence that household debt also causally deteriorates physical and mental health. However, there is no causal effect on being obese.Debt, health satisfaction, mental health, obesity, fixed-effects

In Absolute or Relative Terms?: How Framing Prices Affects the Consumer Price Sensitivity of Health Plan Choice

This paper provides field evidence on (a) how price framing affects consumers' decision to switch health insurance plans and (b) how the price elasticity of demand for health insurance can be influenced by policymakers through simple regulatory efforts. In 2009, in order to foster competition among health insurance companies, German federal regulation required health insurance companies to express price differences between health plans in absolute Euro values rather than percentage point payroll tax differences. Using individuallevel panel data, as well as aggregated health plan-level panel data, we find that the reform led to a sixfold increase in an individual's switching probability and a threefold demand elasticity increase.Health insurance, health plan switching, price competition, price elasticity, SOEP

In Absolute or Relative Terms? How Framing Prices Affects the Consumer Price Sensitivity of Health Plan Choice

This paper provides field evidence on (a) how price framing affects consumers' decision to switch health insurance plans and (b) how the price elasticity of demand for health insurance can be influenced by policymakers through simple regulatory efforts. In 2009, in order to foster competition among health insurance companies, German federal regulation required health insurance companies to express price differences between health plans in absolute Euro values rather than percentage point payroll tax differences. Using individual-level panel data, as well as aggregated health plan-level panel data, we find that the reform led to a sixfold increase in an individual's switching probability and a threefold demand elasticity increase.health insurance, health plan switching, price competition, price elasticity, SOEP

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.Hospital efficiency, ownership, stochastic frontier analysis, profit function

Searching for sources of inefficiency in the German health care sector: demand-side, supply-side, and labour-force-status effects on health and health care utilisation

Die Dissertation beschäftigt sich hauptsächlich mit der empirischen Untersuchung von Anreizeffekten der Krankenversicherung in Deutschland, sowohl für Nachfrager nach Gesundheitsleistungen (Patienten und Versicherte) als auch für Anbieter (Ärzte). Auf der Nachfrageseite wird analysiert, inwieweit der Krankenversicherungsvertrag die Nachfrage nach Arztbesuchen beeinflusst, nachdem für individuelle Charakteristika wie Bildung, Einkommen, vor allem aber den Gesundheitszustand kontrolliert wurde. Bei Privatversicherten wird unterschieden zwischen Inhabern von Krankenversicherungsverträgen mit und ohne Selbstbehalt. Bei gesetzlich Versicherten wird unterschieden zwischen Patienten mit und ohne private Zusatzversicherung für ambulante Leistungen. Die Datenbasis ist – wie in allen folgenden Abschnitten – das Sozioökonomische Panel (SOEP). Auf der Angebotsseite wird analysiert, inwieweit die unterschiedliche Vergütung, die niedergelassene Ärzte für unterschiedlich Versicherte bei gleicher Behandlung erhalten, einen Einfluss auf die Dauer der Behandlungen hat. Hier wird untersucht, inwieweit die Reform des Vergütungssystems im Juli 1997 für die Behandlung gesetzlich Versicherter einen Einfluss auf die Zahl der Arztbesuche hat. Das dritte Kapitel befasst sich mit der Untersuchung, wer private Zusatzversicherung für Krankenhausleistungen (Einzel- oder Doppelzimmer und Chefarztbehandlung) kauft und ob Personen mit Zusatzversicherung mehr Krankenhausleistungen in Anspruch nehmen. Dabei wird untersucht, ob es Informationsasymmetrien zwischen Versicherungsnehmern und den Versicherungsunternehmen gibt und wie diese aussehen. Der besondere Fokus liegt dabei auf dem Einfluss der Risikoaversion (als private Information des Versicherungsnehmers) auf die Nachfrage nach Versicherung. In einem abschließenden Kapitel untersucht die Arbeit den kausalen Effekt von Arbeitslosigkeit auf den Gesundheitszustand. Neben der Kontrolle für unbeobachtbare individuenspezifische Effekte, die gleichzeitig die Wahrscheinlichkeit erhöhen, arbeitslos zu werden und einen schlechteren Gesundheitszustand zu haben, schließt diese Arbeit auch explizit umgekehrte Kausalität (von schlechter Gesundheit zu Arbeitslosigkeit) aus. Ersteres geschieht durch Nutzung eines Fixed-Effects-Modells, Letzteres durch Betrachtung von Personen, die durch Schließung ihrer Betriebsstelle arbeitslos geworden sind und nicht etwa aus anderen Gründen entlassen wurden oder selbst gekündigt haben