942 research outputs found
Demographic development and moral hazard: Health insurance with medical savings accounts
In times of ever-rising health expenditures it is becoming more and more obvious that conventional models for funding health care are increasingly experiencing difficulties in meeting up this challenge. The concept of Medical Savings Accounts (MSAs) represents an innovative and so far rarely analysed alternative for the funding of health care systems. In this concept an anticipated amount of money needed is saved up ex ante by each individual in a special account set aside to cover health care expenses. Since, however, health care expenses for certain kinds of treatment frequently exceed the financial capacity of the individual, Medical Savings Accounts are normally introduced in combination with health insurance covering defined services with higher financial risk. From a theoretical point of view the MSA concept helps counteracting the phenomenon of moral hazard in health insurance systems and at the same time coping with the future challenges posed by demographic development. This paper also examines first experiences gained so far with the implementation and use of Medical Savings Accounts in different countries. It draws a mixed but rather positive picture of the results. Therefore it could be feasible to integrate certain elements of this concept into health care systems of European countries. -- Das Konzept der Medical Savings Accounts als Instrument zur Finanzierung von Gesundheitssystemen hat in den letzten Jahren international Aufmerksamkeit erregt. Länder wie Singapur, Südafrika, China und die USA haben diese neue Form der Finanzierung bereits eingeführt oder in Pilotprojekten erprobt. Dieser Beitrag gibt zunächst einen Überblick über Erfahrungen, die einzelne Länder bisher mit der Konzeption der Medical Savings Accounts gemacht haben. Er geht auf aktuelle Entwicklungen in diesen Ländern ein. Außerdem wird anhand erster Ergebnisse aufgezeigt, dass sich das Modell der Gesundheitssparkonten sowohl als Tarifmodell für private Krankenversicherung sowie als konstitutiver Bestandteil eines gesetzlichen Krankenversicherungssystems bewährt hat. Abschließend wird vorgeschlagen, bestimmte Elemente dieses Systems in die Krankenversicherungssysteme Europas zu integrieren.
Changes in Hospital Efficiency after Privatization
We investigated the effects of privatization on hospital efficiency in Germany. To do so, we obtained bootstrapped DEA efficiency scores in the first stage of our analysis and subsequently employed a difference-in-difference matching approach within a panel regression framework. Our findings show that conversions from public to private for-profit status were associated with an increase in efficiency of between 3.2 and 5.4%. We defined four alternative post- privatization periods and found that the increase in efficiency after a conversion to private for- profit status appeared to be permanent. We also observed an increase in efficiency one year after hospitals were converted to private non-profit status, but our estimations suggest that this effect was transitory. Our findings also show that the efficiency gains after a conversion to private for-profit status were achieved through substantial decreases in staffing ratios in all analyzed staff categories with the exception of physicians. It was also striking that the efficiency gains of hospitals converted to for-profit status were significantly lower in the DRG era than in the pre-DRG era. Altogether, our results suggest that converting hospitals to private for-profit status may be an effective way to ensure the scarce resources in the hospital sector are used more efficiently.Privatization, Performance measurement, Data envelopment analysis, Propensity score matching, Germany
Towards sustainable health care systems: Strategies in health insurance schemes in France, Germany, Japan and the Netherlands ; a comparative study
In all four countries health care expenditures grow while the revenue remains at the same level or even shrinks in many cases. Due to medical progress, ageing and many other factors the gap is widening over time. The pay-as-you-go approach is running against limits either with rising employer and employee contribution rates as is the case in the so-called Bismarck-Systems or with higher taxes in the so-called Beveridge-systems. There are differences regarding the solutions of each country to tackle the described challenge and they might be able to learn from each other if they are compared. Therefore the study compares the health care systems of France, Germany, Japan and the Netherlands. Due to the complexity of the different institutional settings it seems necessary to select certain criteria in order to make a comparison at all possible. The comparison is divided into three different sections. The institutional and organizational framework as first section compares the general organization of social health insurance in all four countries. It comprises the benefit structure, the enrolment, ownership issues and other criteria. The second section focuses on the funding of social health insurance comparing the different approaches according to criteria like contribution rates, contribution assessment bases, burden of contributions and others. The final section analyses different strategies in the provision and purchasing of health services in the four countries. Next to other hospital ownership infrastructure characteristics play an important role in this section. In the last part of the study certain lessons are drawn from the comparison of the four countries. Furthermore certain developments are described which can be anticipated for the future of social health insurance systems. -- Sowohl die demographische Entwicklung als auch vielfältige medizinische und medizinisch-technische Fortschritte führten in den letzten Jahren zu starken Ausgabensteigerungen in den sozialen Krankenversicherungssystemen. Neben Deutschland sind von dieser Entwicklung auch andere Länder mit sozialen Krankenversicherungssystemen betroffen. Die vorliegende Studie nimmt einen systematischen Vergleich zwischen verschiedenen Ländern vor, deren Gesundheitssystem auf einer sozialen Krankenversicherung aufbaut: Deutschland, Frankreich, Japan und die Niederlande. Anhand definierter Kriterien werden die unterschiedlichen Ausprägungsformen im Hinblick auf den organisatorischen und institutionellen Rahmen, die Mittelaufbringung sowie die Leistungserbringung bzw. die Mittelverwendung der einzelnen Länder verglichen. Anschließend werden mögliche Handlungsstrategien aus dem Vergleich abgeleitet, um den zukünftigen Herausforderungen zu begegnen und eine nachhaltige Entwicklung der sozialen Krankenversicherungssysteme sicherzustellen. Abschließend werden bestimmte Entwicklungen beschrieben, die für die sozialen Krankenversicherungssysteme antizipiert werden können.
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, SOEP
The use of cost accounting methodologies to determine prices in German health care
In many sectors of the health care system, prices at which providers are reimbursed by payers are not determined by the market mechanism, but rather by a defined administrative process. Depending on the sector, prices are set politically and are negotiated between different actors or are calculated according to a defined procedure, considering cost data from a sample of providers. The selected approach for price setting determines decisively, to which extent prices for certain services reflect the actual costs incurred for these services. A lack of reflection of actual costs can lead to unintended incentives for providers and therefore have implications on the allocative efficiency. Our analysis shows that in Germanys inpatient and outpatient sector, cost data is increasingly considered for price setting while in other sectors such as long-term care and rehabilitation, the use of cost data is still very limited. However, DRG-cost-weights in the inpatient sector insufficiently reflect actual costs incurred. Thus, decision makers in the German health care system rely more on cost data for price setting and improving the accuracy of cost calculations in order to increase allocative efficiency. -- Die Preisbildung für die Erstattung von Leistungserbringern erfolgt in vielen Sektoren des Gesundheitswesens nicht durch den Marktmechanismus, sondern durch einen administrativ definierten Prozess. Je nach Sektor werden politische Preise vorgegeben, unter den Akteuren verhandelt oder nach einem festgelegten Verfahren, unter Berücksichtigung von Kostendaten aus einer Stichprobe von Leistungserbringern, berechnet. Das gewählte Verfahren der Preisbildung determiniert in entscheidendem Maße, inwieweit die Preise für die erbrachten Leistungen die realen Kosten der Leistungserbringer für diese abbilden. Eine mangelnde Reflektion der Kosten in den Preisen kann zu Fehlanreizen für die Leistungserbringer und mithin zu einer Fehlallokation von Ressourcen führen. Im Rahmen dieser Untersuchung zeigt sich, dass in Deutschland im stationären und ambulanten Bereich zunehmend detaillierte Kostendaten für die Preisberechnung herangezogen werden, während dies in anderen Sektoren wie Pflege und Rehabilitation bislang nur sehr bedingt erfolgt. Es zeigt sich jedoch, dass auch im stationären Sektor die DRG-Relativgewichte bislang nur unzureichend die Kosten für die entsprechenden Leistungen abbilden. Insgesamt muss in Deutschland für die Preisbildung im Gesundheitswesen mehr auf Kosteninformationen für die Preisberechnung zurückgegriffen und die Verursachungsgerechtigkeit der Kostenkalkulationen verbessert werden, um die Allokationseffizienz zu erhöhen.
Managing pharmaceutical regulation in Germany: Overview and economic assessment
Rising costs in pharmaceutical expenditure have become a major concern for policy makers in Germany over the last years. Therefore the pharmaceutical market in Germany has been increasingly targeted by different kinds of regulations, focussing both on the supply and the demand side, using price, volume and spending controls. Specific regulations include price reductions, reference pricing, pharmacy rebate for sickness funds, increasing co-payments, an aut-idem substitution, parallel imports, negative list, guidelines, and finally spending caps for pharmaceutical expenditure per physicians association. Although it is difficult to attribute certain effects to single measures, some measures like reference pricing and physician spending caps are more effective and long-lasting than others. Although highly disputed among physicians, the spending caps applied between 1993 and 2001 have limited pharmaceutical expenditure for an entire decade. However, while some measures do effectively control expenditures, their effect on allocative efficiency may be negative. -- Steigende Ausgaben für Arzneimittel stellen zunehmend ein Problem für Entscheidungsträger in Politik und Selbstverwaltung dar. Daher war der Arzneimittelmarkt in den letzten Jahren Ziel verschiedener Regulierungsformen, die sowohl auf der Angebotsseite als auch auf der Nachfrageseite ansetzen und sowohl Instrumente zur Preis, Mengen als auch Ausgabenregulierung nutzen. Sie umfassen dabei insbesondere Preisrabatte, Festbeträge, Zuzahlungen, Aut-idem substitution, Parallelimporte, Negativlisten, Leitlinien and Arzneimittelbudgets. Obwohl es schwierig ist, bestimmte Wirkungen monokausal auf einzelne Maßnahmen zu zurückzuführen, kann festgestellt werden, dass Arzneimittelbudgets und Festpreise nachhaltiger und effektiver als andere Regulierungsformen sind. Obwohl Arzneimittelbudgets bei niedergelassenen Ärzten sehr umstritten sind, waren sie hauptverantwortlich für die Begrenzung der Arzneimittelausgaben zwischen 1993 und 2001. Daneben existieren einige Regulierungsformen die zwar die Arzneimittel-ausgaben wirksam senken, deren allokative Effizienz jedoch insgesamt eher negativ ist.
Medical savings accounts: Eine internationale Bestandsaufnahme des Konzeptes der Gesundheitssparkonten
Das Konzept der Medical Savings Accounts als Instrument zur Finanzierung von Gesundheitssystemen hat in den letzten Jahren international Aufmerksamkeit erregt. In Deutschland wurde ein ähnliches Konzept für die Gesetzliche Rentenversicherung im Rahmen der Riester Rente diskutiert. Länder wie Singapur, Südafrika, China und die USA haben diese neue Form der Finanzierung bereits eingeführt oder in Pilotprojekten erprobt. Dieser Beitrag gibt zunächst einen Überblick über Erfahrungen, die einzelne Länder bisher mit der Konzeption der Medical Savings Accounts gemacht haben. Außerdem wird anhand erster Ergebnisse aufgezeigt, dass die beschriebenen Länder überwiegend positive Erfahrungen mit diesem Konzept gemacht haben. Abschließend wird vorgeschlagen, dieses Konzept zur Lösung der Finanzierungsprobleme der Gesetzlichen Krankenversicherung auf Deutschland zu übertragen. -- Medical Savings Accounts have gained rapid popularity in the international discussion as a means for financing health care over the last years. In Germany a similar idea has been discussed for the German Pension System known as the so called Riester Rente. Countries like Singapore, South Africa, China and the USA have already introduced Medical Savings Accounts or are conducting pilot studies. This article summarizes the experience with Medical Savings Accounts in these countries and tries to evaluate first results, which are primarily positive so far. Finally it is suggested to introduce the concept of Medical Savings Accounts in the German Public Health Insurance in order to tackle its financing problems.
Defining the “Health Benefit Basket” in nine European countries: Evidence from the European Union Health BASKET Project
This article identifies and analyses a framework for “health baskets,” the taxonomy of benefit catalogues for curative services, and the criteria for the in- or exclusion of benefits in nine EU member states (Denmark, England, France, Germany, Hungary, Italy, The Netherlands, Poland and Spain). Focusing on services of curative care, it is found that the explicitness of benefit catalogues varies largely between the countries. In the absence of explicitly defined benefit catalogues, in- and outpatient remuneration schemes have the character of benefit catalogues. The criteria for the in- or exclusion into benefit catalogues are often not transparent and (cost-)effectiveness is applied only for certain sectors. An EU-wide harmonization of benefit baskets does not seem realistic in the short or medium term as the variation in criteria and the taxonomies of benefit catalogues are large but not insurmountable. There may be scope for a European core basket
Gerechtigkeit in Gesundheitssystemen aus ökonomischer Perspektive
Angesichts steigender Gesundheitsausgaben spielen Gesundheitssystemvergleiche in den letzten Jahren eine immer größere Rolle. Solche Benchmarks können sinnvolle Anregungen zur Verbesserung von Gesundheitssystemen darstellen. Viele Gesundheitssystemvergleiche unterstellen implizit ein universales Gerechtigkeitsverständnis der verglichenen Länder. Diese Annahme ist jedoch bei genauerer Betrachtung nicht haltbar. Eine Übertragbarkeit einzelner Elemente von Gesundheitssystemen ist jedoch vor dem Hintergrund divergenter Gerechtigkeitsverständnisse von Ländern und Kulturkreisen nicht immer gegeben. Eine Übertragung bedarf einer differenzierten Prüfung des Gerechtigkeitsverständnisses der jeweiligen Länder. Dieser Beitrag analysiert den Einfluss verschiedener Gerechtigkeitsverständnisse auf die Ausgestaltung von Gesundheitssystemen. Dabei werden Gerechtigkeitstheorien nach Rawls, Nozick und Konfuzius stellvertretend für mögliche Ausprägungen des Gerechtigkeitsverständnisses verschiedener Kulturkreise dargestellt und deren Einfluss auf die Ausgestaltung von Gesundheitssystemen untersucht. Am Beispiel der Mittelaufbringung in Gesundheitssystemen wird deutlich, dass die drei Gerechtigkeitstheorien insbesondere im Hinblick auf die Rolle des Staates deutlich abweichende Vorstellungen bezüglich eines gerechten Gesundheitssystems aufweisen. -- Due to rising health care expenditure international comparisons of health care systems are recently gaining more importance. These benchmarks can provide interesting information for improving health care systems. Many of these comparisons implicitly assume that countries have a universal understanding of justice. But this assumption is rather questionable. With regard to the existing cultural differences in the understanding of justice the transferability of elements of health care systems is not always given. A transfer usually requires a thorough examination of the ideas of justice in each country. This article analyses the influence of different ideas of justice on the design of health care systems. In this context theories of justice of Rawls, Nozick and Confucius representing the possible understanding of justice in different cultures are displayed and analysed with regards to their influence on health care systems. The example of financing health care lays bare that the three theories of justice have very different consequences for designing health care systems especially concerning the role of governments.Gesundheitssystem,Finanzierung von Gesundheitsleistungen,Gerechtigkeit,Rawls,Nozick,Konfuzius,health care system,health care financing,justice,Rawls,Nozick,Confucius
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