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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.
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.
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.
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.
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.
Das Hamburger Beihilfemodell
(2017)
Zu Beginn ihrer Karriere verfügen Beamte über das Privileg zwischen einer Absicherung im System der gesetzlichen Krankenversicherungen (GKV) und den privaten Krankenversicherungen (PKV) wählen zu dürfen. Bislang entscheiden sich die meisten Beamten für letztere, auch weil sie in der GKV sowohl Arbeitnehmerals auch Arbeitgeberbeitrag zahlen müssten, in der PKV dagegen eine Kostenbeteiligung im Rahmen der Beihilfe vorgesehen ist. Die Stadt Hamburg hat nun jedoch beschlossen, zukünftig Arbeitgeberzuschüsse zur GKV zu leisten, um damit eine „echte Wahlfreiheit“ herzustellen. Wir zeigen anhand eines Vergleichs der internen Renditen in beiden Systemen, dass sich das Kalkül für den Durchschnittsbeamten trotz dieser gefeierten Reform kaum verändern wird. Vielmehr wird es wahrscheinlich zu einer verstärkten adversen Selektion von hohen Gesundheitsrisiken zu Lasten der GKV kommen.
In der deutschen Gesundheitspolitik wird seit langem unter dem Stichwort Bürgerversicherung über die Einbeziehung aller Bürger in das System der Gesetzlichen Krankenversicherung diskutiert. Dabei wird meistens die Perspektive der GKVVersicherten eingenommen, seltener diejenige der Versicherten der PKV. Es stellt sich jedoch insbesondere für die Gruppe der Beihilfeberechtigten die Frage, welche monetären Konsequenzen durch eine Bürgerversicherung für sie entstehen und in welcher Höhe daraus Kompensationszahlungen abgeleitet werden können. Unsere Ergebnisse zeigen: Selbst, wenn diese Kompensationen weniger als die Hälfte der Differenz der Versicherungsleistungen zwischen PKV/Beihilfe und einer
Bürgerversicherung abdecken, hat der Business Case Bürgerversicherung für die Gebietskörperschaften zumindest kurzfristig negative fiskalischen Folgen.
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.
The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. The most visible effect of AMR, healthcare-associated infections (HAIs), imposes a substantial financial burden on the healthcare system through exacerbation or prolongation of illness and subsequent in-hospital treatment. The impact of the emergence and spread of AMR, however, is not limited to an increase in the number of HAIs. AMR also impacts patients who do not become infected. As in-hospital resistance patterns change over time, rationale weighting induces decision-makers to adjust their behaviour in order to provide the best possible treatment in a changing environment of resistance. In settings where resistant organisms are prevalent, for instance, physicians routinely change empirical antibiotic therapy in accordance to the relevant resistance indicator, leading to differences in costs, dosing schedules, and/or side-effect profiles.
The effects of such resistance-induced antibiotic substitution effects are highly relevant in intensive care units (ICUs) where treatment failure often has severe consequences. In ICU settings, first line antibiotic therapy is highly standardized and widely empiric. On the other hand, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first-line therapy. We hypothesize that a rise in resistance to first line agents increases demand for the respective reserve agents. In order to provide first estimates of these resistance-induced substitution effects, we conducted a panel data regression analysis on monthly antibiotic use and resistance data from 66 ICUs between 2001 and 2012.
We chose an estimation using unit-fixed effects and selected combinations of first line agents and their substituting reserve agent in accordance with an expert opinion-guided and pre-defined set of variables. The investigated reserve antibiotics (Carbapenems, Glycopeptides and Linezolid) represent a large part of all reserve antibiotics and on average 15% of all prescribed antibiotics.
The findings of the three core regressions support the hypothesis that demand for antibiotics significantly increases when lower level resistance rises. For some regressions the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. In contrast, there is no lagged effect related to the occurrence of methicillin-resistant Staphylococcus aureus (MRSA). This may be explained by the availability of rapid testing, which is increasingly used to immediately screen patients for MRSA, commonly resulting in definitive therapy being promptly available.
The results are robust to different specifications of the empirical model, and the findings imply that expectations play an important role in the demand for antibiotics. For policy makers, an important finding may be that the availability and accuracy of information about prevalence of pathogens and resistance rates can increase treatment optimality by allowing physicians to efficiently balance the trade-off of resistance and treatment success.
Die vorliegende Arbeit befasst sich auf Basis von Routinedaten der AOK-Plus mit Pflegeverläufen von über 60-Jährigen in Deutschland. Unsere Analysen zeigen eine rechtsschiefe Verteilung der Pflegeverläufe für beide Ge-schlechter. Demnach sind 50 Prozent der weiblichen (männlichen) Pflegefälle nach 45 (26) Monaten verstorben, wohingegen die mittlere Verweildauer in der Pflege bei 51,4 (36,6) Monaten liegt. Die mit diesen Pflegverläufen verbundenen Gesamtkosten der Pflege summieren sich nach unseren Berechnungen im Mittel auf einen Barwert von 68.871 (45.233) Euro. Die Analyse der Pflegestufen mittels eines multinominalen logistischen Modells zeigt für die vorliegenden Daten zudem, dass im Beobachtungszeitraum eine Kompression der Pflegeverläufe stattge-funden hat. So wird eine höhere Pflegestufe und somit ein schwerwiegenderer Pflegeverlauf mit zunehmendem Abstand vom Tod sowie zunehmendem Alter für beide Geschlechter unwahrscheinlicher.