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

Financing health care in high-income countries

The main lesson from the experience of high-income countries with health care financing is a simple one: financing reforms should support the ultimate goal of universal coverage. Most high-income countries started with voluntary health insurance systems, which were then gradually extended to compulsory social insurance for certain groups and finally reached universal coverage, either as nationwide social health insurance schemes or as tax-financed national health services. The risk pooling and prepayment functions are essential. Moreover, the revenue collection mechanisms, whether as general tax revenues or payroll taxes, are secondary to the basic object of providing financial protection through effective risk pooling mechanisms. The experience of high-income countries indicates that private health insurance, medical savings accounts, and other forms of private resource collection are supplementary methods for increasing universal coverage.

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 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

Adoption Decisions for Medical Devices

Decisions to adopt medical devices at the hospital level have consequences for health technology assessment (HTA) on system level and are therefore important to decision makers. Our aim was to investigate the characteristics of organizations and individuals that are more inclined to adopt and utilize cardiovascular devices based on a comprehensive analysis of environmental, organizational, individual, and technological factors and to identify corresponding implications for HTA. Seven random intercept hurdle models were estimated using the data obtained from 1249 surveys completed by members of the European Society of Cardiology. The major findings were that better manufacturer support increased the adoption probability of 'new' devices (i.e. in terms of CE mark approval dates), and that budget pressure increased the adoption probability of 'old' devices. Based on our findings, we suggest investigating the role of manufacturer support in more detail to identify diffusion patterns relevant to HTA on system level, to verify whether it functions as a substitute for medical evidence of new devices, and to receive new insights about its relationship with clinical effectiveness and cost-effectiveness. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd

Medical Savings Accounts – Eine ökonomische Analyse des Konzeptes der Gesundheitssparkonten unter besonderer Berücksichtigung des Gesundheitssystems in Singapur

Angesichts ständig steigender Beiträge wird zunehmend deutlich, dass das deutsche System zur Finanzierung der Gesetzlichen Krankenversicherung strukturelle Schwächen aufweist. Es gilt daher, das existierende Finanzierungsmodell auf den Prüfstand zu stellen und nach innovativen Lösungsalternativen zu suchen. In dem vorliegenden Beitrag zeigt der Autor mit dem Modell der Gesundheitssparkonten neue Wege zur Finanzierung von Gesundheitssystemen auf. Am Beispiel Singapurs wird das Konzept der Gesundheitssparkonten im Hinblick auf allokative und distributive Aspekte untersucht. Ergänzt wird diese ökonomisch geleitete Analyse durch eine gerechtigkeitstheoretische Sichtweise. Anschließend wird ein Reformmodell mit Gesundheitssparkonten für eine nachhaltige Finanzierung der deutschen gesetzlichen Krankenversicherung entwickelt. Der Beitrag weist einen überzeugenden Ausweg aus der Misere des derzeitigen Finanzierungssystems der Gesetzlichen Krankenversicherung und richtet sich an Fachleute in Wissenschaft und Praxis, die sich für die Finanzierung von Gesundheitssystemen interessieren. Der Autor erhielt für diese Studie den Wolfgang-Ritter-Preis und den Wissenschaftspreis für Recht und Politik im Gesundheitswesen.

Mobilisierung von Netzwerkressourcen in einem vertikal integrierten Gesundheitsnetzwerk – Das Beispiel der US-Veteran Health Administration

Vernetzung ist einer der Orientierungspunkte bei der Reform des Gesundheitswesens. Dabei werden Wettbewerb und Kooperation neu gestaltet zwischen Leistungsanbietern in Krankenhausverbünden, Franchisesystemen, Ärzte- und Pflegenetzwerken über integrierte Versorgungsstrukturen bis hin zu Systemen von Managed Care und Corporate Health Management. Viele dieser Vernetzungskonzepte befinden sich noch in der Erprobung, gleichwohl liegen schon erste Praxiserfahrungen vor. Der Band diskutiert grundlegende Probleme und Paradoxien der Vernetzung im Gesundheitswesen. Zu Wort kommen neben Praktikern auch Wissenschaftler aus Betriebswirtschaftslehre und Soziologie.

Management im Gesundheitswesen

In Zeiten sinkender Ressourcen werden im Gesundheitswesen zunehmend kompetente Fach- und Führungskräfte im Managementbereich benötigt, die über eine interdisziplinäre Ausrichtung verfügen und mit den speziellen institutionellen Gegebenheiten des Gesundheitswesens vertraut sind. Die 2., komplett aktualisierte und ergänzte Auflage des Lehrbuches stellt alle wichtigen Aspekte des Managements von Einrichtungen im Gesundheitswesen umfassend dar. Didaktisch aufbereitet folgen alle Themenblöcke einer einheitlichen Struktur mit einer Einführung zu den gesetzlichen, strukturellen und methodischen Grundlagen. Ausführlich wird auf die speziellen Anforderungen und ihre praktische Umsetzung in den Sektoren des Gesundheitswesens eingegangen: gesetzliche und private Krankenversicherungen, Krankenhäuser, Arztpraxen und Ärztenetze, Arzneimittelindustrie und Netzwerke zur integrierten Versorgung. Plus: Fallstudien vertiefen wichtige Aspekte der praktischen Anwendung und eignen sich gut als Material für Unterricht bzw. Selbststudium.Gesundheitsleistungen - Gesundheitsmanagement - Gesundheitswesen - Leistungsmanagement