Does better information about hospital quality affect patients’ choice? Empirical findings from Germany

Background: Economic theory strongly suggests that better information about the quality of care affects patients’ choice of health service providers. However, we have little empirical evidence about the impact of information provided on provider’s choice in Germany. Problem: In Germany, we recently find publicly available information about hospital quality. For example, 50 percent of the hospitals in the Rhine-Ruhr area do now publish their quality data voluntarily in a comprehensive, understandable and well prepared publication. Empirically, we see a strong demand for this publication. However, we do not have information so far, if – and how – this information affect patients’ choice of hospitals. Data and methodology: We take cross sectional time series data from more than 700.000 patients in the Rhine-Ruhr area and in the Cologne-Bonn area (control group) for the time period 2003 to 2006, i.e. 16 quarters. We examine whether the publication of quality information affects market shares and number of cases of the hospitals as well as travelling distance that patients accept to get to the hospital of their choice. In order to account for hospital-specific heterogeneity, we use fixed and random effects models. Results: First: Hospitals, which publish their quality data voluntarily, do attract more patients – compared to such hospital, that do not publish their quality data. Second: In the group of the publishing hospitals, hospitals with a higher than average quality slightly increased their market shares, whereas hospitals with a lower than average quality lost market shares. Conclusion: The provision of quality data has a significant impact on hospital choice: a higher quality leads to a higher demand. Based on these finding decision makers in hospitals have strong incentives (i) to make quality information publicly available and (ii) to keep their quality of care high.Keywords: Quality of care, Information, Hospital Choice JEL Classifications: I 12, C 33

Who gets a mammogram amongst European women aged 50-69 years and why are there such large differences across European countries?

On the basis of the Survey of Health, Ageing, and Retirement (SHARE), we analyse the determinants of who engages in mammography screening focusing on European women aged 50-69 years. A special emphasis is put on the measurement error of subjective life expectancy and on the measurement and impact of physician quality. Our main findings are that physician quality, better education, having a partner, younger age and better health are associated with higher rates of receipt. The impact of subjective life-expectancy on screening decision substantially increases after taking measurement error into account. In light of the enormous differences in mammography screening rates between the European countries that can be detected even if several individual characteristics are taken into account, we explore in a second step the causes of these screening differences using newly available data from the SHARELIFE. The results reveal that in countries with low screening rates (e.g. Denmark, Greece and Poland) many reasons (financial restrictions, time costs, access barriers, lack of information, not usual and low perceived benefits of screening) are significant predictors of not receiving a mammogram. In contrast in countries with high screening rates such as the Netherlands only beliefs regarding the benefits of mammograms (Not considered to be necessary) and the cause Not usual to get this type of care seem to be important screening barriers. --

Determinants of Avoidable Deaths from Ischaemic Heart Diseases in East and West Germany

The objective of this paper is to identify selected forces of the decrease in the number of avoidable deaths from ischaemic heart diseases (IHD) inWest and East Germany from 1996 to 2004. Our main result reveals that the number of intracardiac catheter facilities,which are an important diagnostic tool for IHD, do significantly account for decreases in avoidable mortality from IHD.This is important, as the modernization of the East German health sector included a considerable catch-up process in the number of IC facilities provided relative to West Germany.Avoidable deaths, ischaemic heart disease, intracardiac catheters, Germany

Die Entwicklung der Ausgaben in der Gesetzlichen Krankenversicherung bis 2050 – bleibende Herausforderung für die deutsche Gesundheitspolitik

In diesem Papier wird das zukünftige Ausgabenvolumen der Gesetzlichen Krankenversicherung (GKV) bis zum Jahr 2050 projiziert. Die Ausgaben werden anhand von linearen Regressionsmodellen (OLS), Vektorautoregressionsmodellen (VAR) und Vektorfehlerkorrekturmodellen (VECM) geschätzt. Sie werden insbesondere durch den medizinisch-technischen Fortschritt und die Entwicklung der Einkommen getrieben. Sofern die jetzige, einkommensabhängige Finanzierung der GKV beibehalten wird, ergeben sich für das Jahr 2050 GKV-Beitragssätze zwischen 27 und 33 Prozent. Würde die Finanzierung im Jahr 2011 auf einkommensunabhängige Kopfpauschalen umgestellt werden, ergäben sich Pauschalen von etwa 100 Euro. Diese würden bis zum Jahr 2050 auf bis zu 670 Euro ansteigen. --

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.Private health insurance, waiting time, German acute care hospitals

Soziale Ungleichheit und Inanspruchnahme medizinischer und präventiver Leistungen in Deutschland: eine empirische Analyse

Auf Grundlage von Daten des 'Survey of Health Ageing and Retirement in Europe' (SHARE) werden in diesem Beitrag einkommensbezogene Ungleichheiten in der Inanspruchnahme medizinischer und präventiver Leistungen in Deutschland analysiert und statistisch erklärt. Die Ergebnisse belegen signifikante Ungleichheiten zu Gunsten höherer Einkommensgruppen bei Facharztkontakten sowie bei Vorsorgeleistungen, die vom Facharzt erbracht werden. Bessere kognitive Fähigkeiten und höhere Bildung sind stark mit der einkommensbezogenen Ungleichheit in der Inanspruchnahme dieser Leistungen assoziiert. Im Gegensatz dazu zeigen sich bei Hausarztleistungen und bei Präventionsleistungen, die vorwiegend vom Hausarzt erbracht werden keine einkommensbezogenen oder nur geringe einkommensbezogene Ungleichheiten. Sollte es Ziel der Gesundheitspolitik sein einkommensbezogene Ungleichheiten in der Inanspruchnahme medizinischer und präventiver Leistungen zu reduzieren, ist deren Abhängigkeit vom Setting zu berücksichtigen. --Prävention,Ungleichheit,Dekomposition

Does better information about hospital quality affect patients’ choice? Empirical findings from Germany

Background: Economic theory strongly suggests that better information about the quality of care affects patients’ choice of health service providers. However, we have little empirical evidence about the impact of information provided on provider’s choice in Germany. Problem: In Germany, we recently find publicly available information about hospital quality. For example, 50 percent of the hospitals in the Rhine-Ruhr area do now publish their quality data voluntarily in a comprehensive, understandable and well prepared publication. Empirically, we see a strong demand for this publication. However, we do not have information so far, if – and how – this information affect patients’ choice of hospitals. Data and methodology: We take cross sectional time series data from more than 700.000 patients in the Rhine-Ruhr area and in the Cologne-Bonn area (control group) for the time period 2003 to 2006, i.e. 16 quarters. We examine whether the publication of quality information affects market shares and number of cases of the hospitals as well as travelling distance that patients accept to get to the hospital of their choice. In order to account for hospital-specific heterogeneity, we use fixed and random effects models. Results: First: Hospitals, which publish their quality data voluntarily, do attract more patients – compared to such hospital, that do not publish their quality data. Second: In the group of the publishing hospitals, hospitals with a higher than average quality slightly increased their market shares, whereas hospitals with a lower than average quality lost market shares. Conclusion: The provision of quality data has a significant impact on hospital choice: a higher quality leads to a higher demand. Based on these finding decision makers in hospitals have strong incentives (i) to make quality information publicly available and (ii) to keep their quality of care high

Does better information about hospital quality affect patients’ choice? Empirical findings from Germany

Background: Economic theory strongly suggests that better information about the quality of care affects patients’ choice of health service providers. However, we have little empirical evidence about the impact of information provided on provider’s choice in Germany. Problem: In Germany, we recently find publicly available information about hospital quality. For example, 50 percent of the hospitals in the Rhine-Ruhr area do now publish their quality data voluntarily in a comprehensive, understandable and well prepared publication. Empirically, we see a strong demand for this publication. However, we do not have information so far, if – and how – this information affect patients’ choice of hospitals. Data and methodology: We take cross sectional time series data from more than 700.000 patients in the Rhine-Ruhr area and in the Cologne-Bonn area (control group) for the time period 2003 to 2006, i.e. 16 quarters. We examine whether the publication of quality information affects market shares and number of cases of the hospitals as well as travelling distance that patients accept to get to the hospital of their choice. In order to account for hospital-specific heterogeneity, we use fixed and random effects models. Results: First: Hospitals, which publish their quality data voluntarily, do attract more patients – compared to such hospital, that do not publish their quality data. Second: In the group of the publishing hospitals, hospitals with a higher than average quality slightly increased their market shares, whereas hospitals with a lower than average quality lost market shares. Conclusion: The provision of quality data has a significant impact on hospital choice: a higher quality leads to a higher demand. Based on these finding decision makers in hospitals have strong incentives (i) to make quality information publicly available and (ii) to keep their quality of care high

The influence of insurance status on waiting times in German acute care hospitals: an empirical analysis of new data

<p>Abstract</p> <p>Background</p> <p>There is an ongoing debate in Germany about the assumption that patients with private health insurance (PHI) benefit from better access to medical care, including shorter waiting times (Lüngen et al. 2008), compared to patients with statutory health insurance (SHI).</p> <p>Problem</p> <p>Existing analyses of the determinants for waiting times in Germany are a) based on patient self-reports and b) do not cover the inpatient sector. This paper aims to fill both gaps by (i) generating new primary data and (ii) analyzing waiting times in German hospitals.</p> <p>Methods</p> <p>We requested individual appointments from 485 hospitals within an experimental study design, allowing us to analyze the impact of PHI versus SHI on waiting times (Asplin et al. 2005).</p> <p>Results</p> <p>In German acute care hospitals patients with PHI have significantly shorter waiting times than patients with SHI.</p> <p>Conclusion</p> <p>Discrimination in waiting times by insurance status does occur in the German acute hospital sector. Since there is very little transparency in treatment quality in Germany, we do not know whether discrimination in waiting times leads to discrimination in the quality of treatment. This is an important issue for future research.</p