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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.
This paper proposes a method for deriving the joint asymptotic distribution of sample proportions when the population and sample size increase jointly to infinity. The joint distribution of the sample proportions is derived by reducing the multi- variate to a univariate problem and applying the Cramer-Wold device. Knowing the asymptotic distribution we are in a position to conduct inference on linear or non-linear functions of the population proportions such as a ratio or the log-odds. We motivate and develop our method by means of a topical epidemiological application, namely the infection fatality rate of a virus such as SARS-CoV-2. We demonstrate that our method can be extended to more general settings of interest.
The profession of anaesthesia technologist is a relatively new profession in Germany. The German hospital Association published the first training guideline in 2011. Likewise the surgical technologist profession, the profession of anaesthesia technologists are not officially certified. Hence, similar disadvantages such as further career restrictions and uncertainties in case of unemployment exist. Even the hospitals need to cover the full training expenses. The training of an anaesthesia technologist lasts three years, containing of practical work experience within the anaesthesia units such as the post-anaesthesia caring unit and a theoretical education. The action site is limited to the anaesthesia units only. An anaesthesia technologist is an assistant to the doctor and takes care of the patient before, during and after the anaesthesia. Since the anaesthesia technologist profession is a very young profession group, little is known about the preferences of this group. However, hospital manager need to understand the individual preferences to be able to provide a target group tailored recruitment.
The motivation was to provide results to inform the human resource management of hospitals about the preferences of the very young profession group of anaesthesia technologist with respect to contribute to a successful development of this profession in order to cope with the current labour shortage crisis.
This paper documents that ECB announcements on monetary policy increase stock market volatility in the euro area (EA) using several volatility measures from January 1999 to December 2019. Employing event study methods, a more pronounced impact exists following the global financial crisis starting in 2007. All assets react similarly so that no national peculiarities arise. The effects also spill over to 12 non-EA markets analyzed. Stock markets are more sensitive to negative monetary policy news than to positive ones. Further weighting the announcements by financial market reactions, stock markets behave in a more heterogeneous way.
We examine the effects of the COVID-19 pandemic on the economic decline expected in Germany in 2020. The magnitude of the economic slump that will occur in 2020 depends on the extent of the slump during the shutdown, on the point in time, at which a significant easing of shutdown occurs, and on the length of adjustment process towards the structures that prevailed before the pandemic. We derive several scenarios and find that the shutdown will only remain in the single-digit percentage range if we apply very optimistic assumptions about the extent of the initial decline in GDP during the shutdown and the speed of adjustment after opening up of the economy. However, assuming that the economic crisis cannot end before the medical crisis ends, which medical experts project not to happen before the end of 2020, such optimistic assumptions do not appear realistic. Hence, we find it more likely that the percentage decline of GDP in Germany will be two-digit in 2020. Our findings are in contrast to the growth projections recently issued by the German Council of Economic Experts or by the Federal Ministry of Economic Affairs and Energy of Germany.
Nursing without caring?
(2019)
We know that existing professions in the health care sector value work environment and job conditions to a great extent. However, we are also witnessing an expansion of new roles into the health care sector, many of which substitutie the tasks of existing professions. This may be efficient, in that it releases professionals’ time. However, there is little understanding of what motivates these new professions in entering or remaining in these newly created roles. This study tries to evaluate the preference structure of one of these new staff groups, surgical technologist, through examining the preferences of trainees, defined over a number of attributes, in this group. The DCE study covers 80% of the target population. The results show a vigorous disfavour towards any perceived nursing job characteristics such as caring activities, hierarchical work environment or shift types. The results inform policy makers and hospital manager about the importance to focus not only on the nursing profession but also to take into account the existence of a group of people who is willing to work within the health care system however, associated with strong preferences against nursing activities, especially caring. Implementing and further development of new and specialised profession through reallocating former nursing tasks- should be considered while coping with labour shortage.
This paper examines the role of uncertainty in the context of the business cycle in the Eurozone. To gain a more granular perspective on uncertainty, the paper decomposes uncertainty along two dimensions: First, we construct the four different moments of uncertainty, including the point estimate, the standard deviation, the skewness and the kurtosis. The second dimension of uncertainty spans along three distinct groups of economic agents, including consumers, corporates and financial markets. Based on this taxonomy, we construct uncertainty indices and assess the impact on real GDP via impulse response functions and further investigate their informational value in rolling out-of-sample GDP forecasts. The analysis lends evidence to the hypothesis that higher uncertainty expressed through the point estimate, a larger standard deviation among confidence estimates, positive skewness and a higher kurtosis are all negatively correlated with the business cycle. The impulse response functions reveal that in particular the first and the second moment of uncertainty cause a permanent effect on GDP with an initial decline and a subsequent overshoot. We find uncertainty in the corporate sector to be the main driver behind this observation, followed by financial markets’ uncertainty whose initial effect on GDP is comparable but receding much faster. While the first two moments of uncertainty improve GDP forecasts significantly, both the skewness and the kurtosis do not augment the forecast quality any further.
This paper examines the recession probabilities for the Eurozone along four different dimensions: First, we identify the best performing indicators for a recession within the next 12 months based on 43 underlying single variables and their different transformations in a benchmark model. We find that a modified version of the yield curve incorporating the shadow interest rate removes the downward rigidity of the front-leg and restores part of the informational content of the term spread at the zero lower bound. However, the best performing single indicator of the benchmark model is Real M1 followed by the Purchasing Managers Index (PMI), the investment grade corporate bond spread and the Terms of Trade. Second, the paper establishes three submodels to increase the lead-time and the stability of recession models: (i) Monetary transmission channels via principal component analysis; (ii) Bivariate regressions to identify paramount combinations; (iii) Unstable surges vis-à-vis the Hodrick-Prescott trend to detect animal spirits and hawkish mistakes. Third, the analysis is extended over various forecasting horizons (6m, 18m and 24m). Fourth, the results are analyzed from the perspective of risk-affine and risk-averse investors.
Gone with the windfall
(2018)
Due to the debate about the generosity of LTC insurance benefits the German government decided to increase benefits and widen the circle of LTC beneficiaries with the Second LTC Strengthening Act. In this paper, we evaluate the long-term implications of this recent reform for the German LTC insurance scheme. Using the framework of generational accounting we show that the reform has led to a widening of the short-term gap between revenues and expenditure and that the LTC insurance is not sustainably financed, neither pre- nor post-reform. By the early 2020s there will be fiscal pressure for further reforms. From an intergenerational perspective, the reform can be seen as a windfall to current beneficiaries increasing the intergenerational redistribution through the pay-as-you-go system.
This paper develops techniques of estimation and inference in a prototypical macroeconomic adaptive learning model with slowly decreasing gains. A sequential three-step procedure based on a `super-consistent' estimator of the rational expectations equilibrium parameter is proposed. It is shown that this procedure is asymptotically equivalent to first estimating the structural parameters jointly via ordinary least-squares (OLS) and then using the so-obtained estimates to form a plug-in estimator of the rational expectations equilibrium parameter. In spite of failing Grenander's conditions for well-behaved data, a limiting normal distribution of the estimators centered at the true parameters is derived. Although this distribution is singular, it can nevertheless be used to draw inferences about joint restrictions by applying results from Andrews (1987) to show that Wald-type statistics remain valid when equipped with a pseudo-inverse. Monte-Carlo evidence confirms the accuracy of the asymptotic theory for the finite sample behaviour of estimators and test statistics discussed here.
We analyze the effects of limited feedback on beliefs and contributions in a repeated public goods game setting. In a first experiment, we test whether exogenously determined feedback about a good example (i.e., the maximum contribution in a period) in contrast to a bad example (i.e., the minimum contribution in a period) induces higher contributions. We find that when the type of feedback is not transparent to the group members, good examples boost cooperation while bad examples hamper it. There is no difference when the type of feedback is transparent. In a second experiment, feedback is endogenously chosen by a group leader. The results show that a large majority of the group leaders count on the positive effect of providing a good example. This is true regardless whether they choose the feedback type to be transparent or non-transparent. Half of the group leaders make the type of feedback transparent. With endogenously chosen feedback about good examples no difference in contributions can be observed among transparent and non-transparent feedback selection. In both experiments feedback shapes subjects’ beliefs. With exogenously chosen feedback, transparent feedback tends to reduce beliefs when good examples are provided as feedback and tends to increase beliefs in when bad examples are provided as feedback compared to the respective non-transparent cases. Our results shed new light on the design of feedback rovision in public goods settings.
This paper employs event study methods to evaluate the effects of ECB’s nonstandard monetary policy program announcements on 10-year government bond yields of euro area member states. It covers data from 11 euro area countries from January 1, 2007 to August 31, 2017 and distinguishes between the more solvent countries (Austria, Belgium, Finland, France, Germany, the Netherlands) and the less solvent ones (Greece, Ireland, Italy, Portugal, Spain). The paper makes three contributions to the literature. First, it is the first paper to reveal that measurable effects of announcements arise with a one-day delay meaning that government bond markets take some time to react to ECB announcements. Second, it quantifies the country-specific extent of yield reduction which seems inversely related to the solvency rating of the corresponding countries. The reduction of the spread between both groups in response to an event is due to a stronger decrease in the less solvent group. Third, this result is confirmed by letting the announcement variable interact with the spread level, which is an innovation in this strand of literature. By employing different data as control variables, it turns out that the results are robust for a given event set.
At the beginning of their career civil servants in Germany can choose between the social health insurance (SHI) system and a private plan combined with a direct reimbursement of the government of up to 70 percent. Most civil servants chose the latter, not only but also because they have to cover all contribution payments in the social system themselves, while normal employees get nearly 50 percent from their employers. The city state of Hamburg decided to change the system by paying a share of the contributions if civil servants choose the social plan. We use a stochastic microsimulation model to analyse which socio-economic types of civil servants could benefit from the Hamburg plan and if this changes the mix of insured persons in the SHI system. Our results show that low income and high morbidity types as well as families have a substantially higher incentive to choose SHI. This reform might thereby increase the adverse selection of high risk cases towards SHI.
This paper uses the Consensus Economic Forecast poll to investigate how forecasters in the foreign exchange market form expectations. In order to explain the expectation formation of forecasters, around 50,000 forecasts for 22 OECD-member currencies are analyzed. The results indicate that forecasters do not form expectations rationally when tested for unbiasedness and orthogonality. The results also suggest that forecasts for industrialized economies show a mix of trend-following and fundamentally-oriented behavior. By contrast, forecasts for emerging markets show significantly more destabilizing expectations. We find forecasting tendencies to strengthen in the short-run and medium-run when controlling for the Balassa-Samuelson effect. For long-run forecasts however this can not be confirmed.
In this paper, we study the bias in interest rate projections for four central banks, namely for Czech Republic, New Zealand, Norway, and Sweden. We examine whether central bank projections are based on an asymmetric loss function and report evidence that central banks perceive an overprojection of their longer-term interest rate forecasts as twice as costly as an underprojection of the same size. We document that rationality is consistent with biased interest rate projections which contribute to explaining the central banks’ behavior.
In this article we examine the influence of two goal compensation schemes on lying behavior. Based on the die rolling task of Fischbacher/Föllmi-Heusi (2013), we apply an individual goal incentive scheme and a team goal incentive scheme. In both settings individuals receive a fixed bonus when attaining the goal. We find that under team goal incentives subjects are less inclined to over-report production outputs beyond the amount which is on average necessary for goal attainment. Investigating subjects’ beliefs on their team mates’ behavior under team goal incentives reveals that subjects who either believe that lying is not profitable (i.e., the team goal cannot be reached with a lie) or not absolutely necessary (i.e., there is a good chance that the team goal can also be reached without lying) tend to be honest. We also find that subjects who believe that the team goal has already been reached by their team mates tend to over-report production outputs. Across treatments, women are found to be more honest than men. Subjects’ ersonality is not associated with reported production outputs. Our work contributes to previous research on how different compensation schemes affect unethical behavior in organizational settings.
Our paper estimates the impact of immigration on the sustainability of the Italian public finances using the methodology of Generational Accounting. We take into account socio-economic differences between the main migrants’ communities resident in Italy and we present three possible scenarios to reflect the potential economic degree of integration of foreigners in the Italian territory. Moreover, for each scenario we propose several options for migrants concerning both the length of permanence in Italy and the possible collection of retirement benefits. Our results show that the burden of current fiscal policy reduces as integration of the foreign-born increases. If migrants’ children are economically perfectly integrated, the fiscal gap is reduced from 71.9 to -15.3 percent of GDP.
This paper studies the effect of the strength of Bilateral Investment Treaties (BITs) on FDI activity. We develop an index for the strength of international dispute settlement provisions included in BITs in order to examine the role the content of BITs plays in attracting FDI. To this end we make use of data from the UNCTAD's International Investment Agreement Mapping Project and measure the provision strength of 1,676 BITs. Using panel data of bilateral and total inward FDI flows and stocks we study the effect of BITs on FDI. Our main finding indicates that stronger international dispute settlement provisions in BITs are indeed associated with positive effects on FDI activity.
This study examines heterogeneity in tax rate elasticities of corporate capital using staggered variation in local business tax rates of German municipalities. The results suggest an average long-run capital decline of 0.97% after a 1% increase in the tax rate. In line with prior literature that suggests higher investment-cash flow sensitivities of firms with financing constraints tax rate elasticities are up to half times larger for financially constrained firms than for unconstrained firms. Moreover, capital responses are about half times larger for firms with fewer tax avoidance possibilities. Finally, this study contributes to the literature on tax incidence. I find a weaker relation between taxes and capital for firms that are less likely to bear the economic burden of the tax because they shift the tax incidence to their stakeholders.