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What drives healthcare expenditures - mortality in general or high cost-risk patients and their mortality?

  • Background: In view of steadily rising healthcare expenditures (HCE), studies on spending distributions can provide important guidance for policy decisions. Since the majority of HCE is concentrated in a few high-cost cases, this study focusses on the spending distribution between different cost-risk groups. We show detailed allocation structures, distinguishing several categories of HCE and the survival status of insureds to gain insights regarding the share of mortality costs. Methods: Our analyses rely on data from a large sickness fund that covers around four million insureds. We classify the population into ten equal risk groups by costs and then determine expenditure shares of total HCE and daily per-capita expenditures depending on survival status and risk group affiliation. Results: Our results offer that the often stated dominating effect of mortality costs of HCE is only evident in lower cost-risk groups and almost exclusively attributable to inpatient care. Furthermore, HCE in the calendar year of death is the same for most cost-risk groups, with the exception of risk groups at both ends of the distribution. However, in the case of the highest cost-risk group, the difference between survivors and decedents is proportionally small. The differences in cost structure between decedents in high-risk and other risk groups are primarily attributable to pharmaceutical spending. Conclusion: Short-term high HCE in the year of death occur equally in all cost-risk groups and are hardly avoidable. By contrast, in the extremely high cost-risk groups, the cost difference between the year before death and the year of death is much smaller. Overall, this group remains the main target to influence the rise in HCE and its characteristics should be considered with respect to future HCE projections.

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Metadaten
Author:Valeska Hofbauer-Milan, Stefan Fetzer, Christian Hagist
URN:urn:nbn:de:hbz:992-opus4-9678
Subtitle (English):a distributional analysis of Germany's social health insurance
Series (Serial Number):WHU – Working Paper Series in Economics (WP 23/01)
Publisher:WHU - Otto Beisheim School of Management
Place of publication:Vallendar
Document Type:Working Paper
Language:English
Date of Publication (online):2024/01/08
Publishing Institution:WHU - Otto Beisheim School of Management
Release Date:2024/01/09
Tag:Gesetzliche Krankenversicherung; Gesundheitskosten; Kostenrisikogruppe
Cost risk group; Health expenditure distribution; Social health insurance
Page Number:17
Institutes:WHU Economics Group / Chair of Economic and Social Policy
Licence (German):Copyright for this publication