Diagnosis Related Payment for Inpatient Mental Health Care: Hospital Selection and Effects on Length of Stay.

We study a policy introducing diagnosis related payment for inpatient mental health care in Germany with rates decreasing over length of stay. Using data on all hospital cases, we first examine which hospitals voluntarily opt into the new scheme. We show that specialized hospitals that treat more complicated cases and are reimbursed more highly under the new scheme select into it.

Consequences of early thyroid ultrasound on subsequent tests, morbidity and costs: an explorative analysis of routine health data from German ambulatory care.

Objectives: This study aims to evaluate whether the use of thyroid ultrasound (US) early in the work-up of suspected thyroid disorders triggers cascade effects of medical procedures and to analyse effects on morbidity, healthcare usage and costs.

Study Design: Retrospective analysis of claims data from ambulatory care (2012-2017).

Setting: Primary care in Bavaria, Germany, 13 million inhabitants.

Short- and medium-term cost effects of non-indicated thyroid diagnostics: empirical evidence from German claims data.

This paper contributes to the discussion of whether non-indicated ultrasound examinations of the thyroid gland contribute to overtreatment and excess health care expenditures. Using two sources of claims data from Germany, we analyzed data from patients who underwent a TSH blood test which is the initial diagnostic measure to check for possible presence of thyroid dysfunction. In a matching analysis, we compared health costs of two groups of patients.

On the interdependence of ambulatory and hospital care in the German health system.

For some considerable time now the interface between ambulatory and hospital care has been mooted as a cause of inefficiencies in the German health system and there have been calls for a softening of the strict separation between the two sectors. This debate emphasizes the need for detailed empirical information on the interdependence between the two sectors. Using extensive administrative data at the level of the 412 German counties for the years 2007 to 2009 and a simultaneous equation model which allows the numbers of ambulatory and hospital cases to be mutually interdependent, we examine the connection between ambulatory and hospital specialist care separately for ten medical specialties.

Who responds to financial incentives for weight loss? Evidence from a randomized controlled trial.

There is a paucity of evidence on the heterogeneous impacts of financial incentives on weight loss. Between March 2010 and January 2012, in a randomized controlled trial, we assigned 700 obese persons to three experimental arms. We test whether particular subgroups react differently to financial incentives for weight loss.

Who Opts out of the Statutory Health Insurance? A Discrete Time Hazard Model for Germany.

The coexistence of social health insurance and private health insurance in Germany is subject to intense public debate. As only few have the opportunity to choose between the two systems, they are often regarded as privileged by the health insurance system. Applying a hazard model in discrete time, this paper examines the role of incentives set by the regulatory framework and the influence of individual personality characteristics on the decision to opt out of the statutory system.

Self-perceived job insecurity and the demand for medical rehabilitation: does fear of unemployment reduce health care utilization?

An inverse relationship between job insecurity and sickness absence has been established in the literature, which is explained by employees avoiding to send signals of both poor health and uncooperative behavior towards the employer. In this paper, we focus on whether the same mechanism applies to the demand for medical rehabilitation measures. This question has recently gained much interest in the context of the current public debate on presenteeism.

Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?

Due to regional competition and patient migration, the efficiency of healthcare provision at the regional level is subject to spatial dependence. We address this issue by applying a spatial autoregressive model to longitudinal data from Germany at the district ('Kreis') level. The empirical model is specified to explain efficiency scores, which we derive through non-parametric order-m efficiency analysis of regional health production.

Heterogeneity in the intergenerational transmission of alcohol consumption: a quantile regression approach.

This paper addresses the question of whether the effect of parental drinking on children's later consumption of alcohol - which is frequently found to be of positive sign - exhibits a certain pattern of heterogeneity. In particular, if this effect is more prominent in the upper tail than elsewhere in the distribution of children's alcohol consumption, conventional regression analyses that focus on the mean effect may substantially underrate parental drinking as a risk factor for children's later alcohol abuse. In our empirical application, we address this issue by applying censored quantile regression methods to German survey data.

Smoking initiation in Germany: the role of intergenerational transmission.

This paper analyzes the decision to start smoking using data from the German Socio-Economic Panel (GSOEP). Our focus is on the role that parental smoking behavior plays for children's smoking initiation. The data used are a combination of retrospective information on the age individuals started smoking and, by tracing back these individuals within the panel structure up to that point, information on characteristics at the age of smoking initiation.

Elasticities of market shares and social health insurance choice in Germany: a dynamic panel data approach.

In 1996, free choice of health insurers was introduced to the German social health insurance system. One objective was to increase efficiency through competition. A crucial precondition for effective competition among health insurers is that consumers search for lower-priced health insurers.