Suchergebnisse

En este artículo se estudia el impacto de un conjunto de variables sobre la percepción del estado de salud de los individuos en las regiones que establece la Encuesta Nacional de Calidad de Vida (ECV), realizada por el Departamento Administrativo Nacional de Estadísticas, DANE, en 2003. En el trabajo econométrico se utilizaron modelos Probit ordenados donde las variables adoptadas denotan diferentes factores socioeconómicos, demográficos, institucionales y familiares. El análisis por regiones sirvió para probar que existen elementos locales o regionales que hacen que el impacto de los factores que inciden en las condiciones de salud de los individuos difiera de una región a otra. Palabras clave: determinantes de la salud, seguridad social en salud, modelo probit ordenado, economía de la salud, región. Clasificación JEL: I11, I12, C25. Abstract: In this article the impact of a set of variables over the perception of individuals' health state in the regions established by the National Life Quality Survey (ECV) performed by the Administrative National Department of Statistics (DANE) in 2003 is studied. The variables denote socioeconomic and demographic characteristics of individuals, institutional characteristics of the health system, and household characteristics. The econometric exercise is based on the use of ordered probit models for the determination of such impact. The analysis by regions was useful to prove the existence of local or regional elements that make the impact of the factors that impinge on the health conditions of people to differ from region to region. Keywords: health determinants, social security in health, ordered probit models, health economics, region. JEL classification: I11, I12, C25. Résumé: Cet article étudie l'impact d'un ensemble de variables socio-économiques sur la santé des individus. Pour amener à bien cette étude, nous utilisons la classification des régions établit par l'Enquête Nationale de Qualité de Vie (ECV), réalisée en 2003 par le Département Administratif National de Statistique -DANE. Nous utilisons dans le travail économétrique des modèles Probit Ordonnés dont les variables adoptées contiennent différents facteurs socio-économiques, démographiques, institutionnels et familiaux. L'analyse prouve que ces facteurs expliquant la santé des individus diffère entre les régions. Mots clés: déterminants de la santé, sécurité social, modèle probit ordonné, économie de la santé, région. Classification JEL: I11, I12, C25.

The National Resident Matching program seeks a stable matching of medical students to teaching hospitals. With couples, stable matchings need not exist. Nevertheless, for any student preferences, we show that each instance of a matching problem has a "nearby" instance with a stable matching. The nearby instance is obtained by perturbing the capacities of the hospitals. In this perturbation, aggregate capacity is never reduced and can increase by at most four. The capacity of each hospital never changes by more than two. (JEL C78, D47, I11, J41, J44)

Information and Communication Technologies have become a revolutionary part of European healthcare in recent years. The European Commission considers eHealth as an important and appropriate tool that can contribute to cope with the challenges that are currently affecting the healthcare systems in Europe. The development of eHealth is therefore embedded in many EU strategies and is being evaluated on an ongoing basis. In the past, several studies have been carried out focusing on the evaluation of individual areas of eHealth - especially on the area of primary care secured by General Practitioners and Acute Hospitals. However, no synthesis of these works was made. This paper is focused on the proposing of an assessment for both mentioned areas of eHealth. The aim is to evaluate the eHealth deployment in the European Union Member States by the synthesis of Composite Indicators in existing studies into the evaluation model based on the application of Multiple-Criteria Decision-Making techniques. The evaluation is performed by the usage of TOPSIS, WSA, and MAPPAC method. The result of the research is the design of an evaluation framework for eHealth that enables the comparison of eHealth indicators in the international context and evaluation of eHealth deployment in European Union Member States in the form of a ranking. In this ranking, the Nordic countries are among the best-rated countries, while the worst-rated countries are in Eastern Europe.

In this paper, we analyze a vertically differentiated mixed duopoly in medical care services. Pollution is the source of illness. The government has a dual role. It decides how much to invest to reduce the pollution level and it may participate in the health market running a public hospital. We find that the presence of the public provider increases the average quality of the service in the market and it reduces the rate of mortality. Furthermore, when the public hospital offers services with the highest quality, then this has positive spillovers on the quality offered by the private provider. Despite these positive welfare improving features, the mixed duopoly in medical care goes along with the highest level of pollution. In the presence of an increasing concern about the relationship between pollution and health, understanding the role of public intervention appears crucial.

The last 40 years have seen a rapid increase of government expenditures on public welfare arrangements. Increasing healthcare expenditures form a significant part of these outlays, and its share of total government expenditure has risen rapidly. This paper argues that the determinants of growth in healthcare expenditure are partly to be found in the way healthcare is organised. As economist William Baumol noted already in the 1960s, personalized services can easily fall into a stagnation trap characterized by rapidly increasing cost inflation. Healthcare today shows clear signs of being a "stagnant personal service" with poor productivity levels compared to other services such as telecommunication. As a result, healthcare inflation is far higher than the standard inflation rate, creating high real costs that push up the expenditure for healthcare. Consequently, we argue for reforms in the organisation of healthcare provisions to reduce the sector's productivity lags in European countries and to reap the benefits that emanates from integration with other markets.

Idee und Ziele des Risikostrukturausgleichs - Der Risikostrukturausgleich (im folgenden: RSA) in der Gesetzlichen Krankenversicherung wurde mit dem Gesundheits-Strukturgesetz von 1993 eingeführt und trat am 1.1.1994 in Kraft. Mit dem selben Gesetz wurden auch die Wahl- und Wechselmöglichkeiten der Versicherungsmitglieder erheblich erweitert und somit der Wettbewerb zwischen den Krankenkassen verschärft. In der Debatte um die Notwendigkeit eines RSA wurden und werden verschiedene Ziele angeführt, die teilweise, aber nicht ausschließlich mit dem Kassenwettbewerb in Beziehung stehen. ; The system of risk equalization payments among German Statutory Sickness Funds is currently under intensive political debate. While some participants claim that the enormous size of the equalization payments are detrimental to effective competition among funds, others argue that there are still funds which engage heavily in risk selection and are thereby able to keep their contribution rates low. In this paper the major options for a modification of the current system are analyzed both theoretically and empirically with respect to their capacity to diminish the spread of contribution rates, while preserving incentives for an efficient delivery of health care services. In particular, we examine the inclusion of additional risk adjusters in the equalization formula and the formation of a high-risk pool. The data suggest that it is indeed possible to improve the formula without diminishing the incentives for efficiency if the risk adjusters "income" and "marital status" are included.

This study examines the effect of the Affordable Care Act's Medicaid expansion on hospital financial outcomes. A key innovation relative to prior studies is that we explicitly account for heterogeneity across states in the timing and extent of the expansion as well as across hospital types. We find that Medicaid expansion led to a decrease in uncompensated care expenditures and an increase in average operating margins. The effects were larger in states where the Medicaid expansion led to a greater increase in program eligibility. Operating margins improved most for public hospitals and facilities located in rural areas. (JEL I11, I13, I18)

El artículo analiza los incentivos en aseguramiento y uso de servicios de los trabajadores, dependientes e independientes, cuando dichos agentes son heterogéneos en su estado de salud. Metodológicamente, los agentes eligen de manera secuencial el nivel de aseguramiento y uso de servicios que maximicen su utilidad intertemporal bajo incertidumbre sobre su estado de salud. Las estimaciones probit bivariadas muestran una relación positiva entre aseguramiento y estado de salud (selección positiva de riesgos), y aseguramiento e incidencia de enfermedad crónica (selección negativa de riesgos) para el grupo de trabajadores independientes. Para el uso de servicios de salud, dado que es una demanda inducida, el seguro de salud aumenta la probabilidad de uso de consulta externa. Palabras clave: capital salud, demanda de servicios de salud, selección de riesgo. Clasificación JEL: I1, I11, I12. Abstract: This paper analyzes the effect of individual health status on the probability of having health insurance and using health services. From the Colombian Living Standard Survey (1997, 2003), we found that the probability of having health insurance if you are self-employed increases either with the self report of a good health status (cream skimming) or the incidence of a chronic illness (self-selection). However, we do not observe those patterns on the group of self-employed workers. Finally, we found, as the research in the field suggests, that the use of health services increases with the health insurance status. Keywords: capital health, demand of medical care, risk selection. JEL Classification: I1, I11, I12. Résumé: L'article analyse les motivations auxquelles sont soumises les travailleurs dépendants et les travailleurs indépendants concernant l'adhésion à une assurance maladie et l'utilisation des services médicaux lorsqu'ils sont hétérogènes par rapport à leur état de santé. Les agents choisissent de manière séquentielle le niveau d'assurance maladie et l'utilisation des services médicaux qui maximisent leur utilité intertemporelle sous la contrainte d'incertitude sur leur état de santé. Les estimations probit bivariées montrent une relation positive entre l'adhésion à une assurance maladie et l'état de santé (sélection positive des risques), et l'adhésion à une assurance maladie et l'effet entraîné par une maladie chronique (sélection négative des risques) par le groupe des travailleurs indépendants. Maintenant, concernant l'utilisation des services médicaux, on montre que l'adhésion à une assurance maladie augmente la probabilité d'utilisation de la consultation externe puisqu'il s'agit d'une demande induite. Mots clef: capital santé, demande des services de santé, sélection des risques. Classification JEL: I1, I11, I12.

Price surges often generate social disapproval and requests for regulation and price controls, but these interventions may cause inefficiencies and shortages. To study how individuals perceive and reason about sudden price increases for different products under different policy regimes, we conduct a survey experiment with Canadian and U.S. residents. Econometric and textual analyses indicate that prices are not seen just as signals of scarcity; they cause widespread opposition and strong and polarized moral reactions. However, acceptance of unregulated prices is higher when potential economic tradeoffs between unregulated and controlled prices are salient and when higher production costs contribute to the price increases. The salience of tradeoffs also reduces the polarization of moral judgments between supporters and opponents of unregulated pricing. In part, the acceptance of free price adjustments is driven by people's overall attitudes about the function of markets and the government in society. These findings are corroborated by a donation experiment, and they suggest that awareness of the causes and potential consequences of price increases may induce less extreme views about the role of market institutions in governing the economy.

In this paper, I study the effect of parallel trade (cross border resale of goods without the authorization of the manufacturer) on pharmaceutical regulation in a North-South framework with a firm's endogenous decision to export to the South. Governments in both countries may limit prices directly via price caps or restrict third-party payer reimbursement for the drug via reimbursement limits. Parallel trade may relax regulation in the source country of parallel imports (South) and intensify regulation in the destination country (North): In the source country, parallel trade may relax regulation both under a price cap and a reimbursement limit under certain conditions. In the destination country, parallel trade has no effect on the level of regulation under a price cap, and it intensifies regulation under a reimbursement limit. Parallel trade may change regulatory preferences: Under no parallel trade, both the source and destination country set prices caps. Under parallel trade, the source country sets a price cap, but the destination country sets a reimbursement, thereby enforcing a higher price cap in the South. This implies higher drug prices under parallel trade in both source and destination country. ; Revised Version March 2019

In this study, we document the effect of Food Stamp access on adult health care utilization. While Food Stamps is one of the largest safety net programs in the U.S. today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants' eligibility for Food Stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to Food Stamps reduced the likelihood of an adult visiting a physician more than twice in one year, but had no significant effect on the likelihood of having any physician visits. This result does not appear to be due to changes in physical or mental health, or due to individuals with common chronic health conditions, leaving open the possibility that changes in nutrition or resources may reduce the need for physician visits. Additionally, we find that for single women, Food Stamps increased the affordability of specialty health care, which may have further reduced the need for physician visits. These findings have important implications for cost-benefit analyses of the Food Stamp program, as reductions in health care utilization due to Food Stamps may offset some of the program's impact on the overall government budget due to the existence of government-provided health insurance programs such as Medicaid.

In this study, we document the effect of food stamp access on adult health care utilization. While the Food Stamp Program provides one of the largest safety nets in the United States today, the universal nature of the program across geographic areas and over time limits the potential for quasi-experimental analysis. To circumvent this, we use variation in documented immigrants' eligibility for food stamps across states and over time due to welfare reform in 1996. Our estimates indicate that access to food stamps reduced physician visits. Additionally, we find that for single women, food stamps increased the affordability of specialty health care. These findings have important implications for cost-benefit analyses of the Food Stamp Program, as reductions in health care utilization because of food stamps may offset some of the program's impact on the overall government budget owing to the existence of government-provided health insurance programs such as Medicaid.

Das Krankenversicherungssystem in Deutschland ist seit Jahren in der Kritik. Reformbedarf besteht sowohl bei der Gesetzlichen als auch bei der Privaten Krankenversicherung. Ist ein einheitlicher Versicherungsmarkt die Lösung? Peter Oberender und Jürgen Zerth, Universität Bayreuth, sehen in der Einführung einer Bürgerversicherung kein adäquates Instrument, die jeweiligen schwächen der GKV und der PKV zu beheben. Nach Ansicht von Stefan Felder, Universität Basel und CINCH Essen, ist die Dreiteilung des deutschen Krankenversicherungssystems historisch überholt, ineffizient und einkommenspolitisch fragwürdig. Sie erweise sich zudem zunehmend als Belastung für die deutsche Wirtschaft. Martin Nell, Universität Hamburg, plädiert für eine Reform des dualen Systems, die die Voraussetzungen für einen fairen Wettbewerb schafft, in dem sich die Unternehmen der GKV und der PKV bewähren müssen. Bei einer Einführung der Bürgerversicherung würde seiner Meinung nach unter Inkaufnahme gravierender juristischer Risiken das duale System zugunsten eines staatlich verordneten, einheitlichen Versicherungsmarktes ohne nennenswerte Produktvielfalt abgewickelt. Bernd Raffelhüschen und Christian Hagist, Universität Freiburg, stellen mit der »neuen Dualität« in der Krankenversicherung eine Alternative zur Einheitskasse vor: Ärzte und Krankenhäuser würden demnach zu Unternehmen, die mit der Gesundheit Geld verdienen wollen und sollen. Die Patienten wären Kunden und bekämen für die Leistungen eine Rechnung, die sie selbst beglichen und deshalb gut kontrollierten, da sie nur einen gewissen Anteil erstattet bekommen würden.