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  • Author: Ansgar Wübker x
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Abstract

We determine the level and development of deficits during the period from 1998 to 2004 in German public hospitals and analyze the reasons for these deficits. Furthermore we discuss their implications for economic policy. In 2004, the deficits reach a peak of 3 billion Euro. Fixed effects estimations suggest that both the duration of treatment and the number of employees have a significant positive influence on the development of the deficits while the number of cases has a significant negative influence. The payment of public hospital deficits out of general budget resources constitutes an unjustified subsidy.

Zusammenfassung:

In Deutschland sind aktuell mehr als 1,5 Millionen Menschen an Demenz erkrankt. Es ist durch die demografischen Prozesse in den nächsten Jahrzehnten jährlich von über 300.000 Neuerkrankungen auszugehen. Gelingen keine revolutionären Fortschritte in Prävention und Therapie, sind extreme Auswirkungen auf die Gesundheitsversorgung zu erwarten. Die Gesundheitspolitik ist gefordert, adäquate Anreize für eine nachhaltige Finanzierung der Pflege und für ausreichendes Pflegepersonal zu schaffen.

Summary

This paper examines, whether well prepared report cards affect hospital choice within Germany. We report three main findings. First: hospitals, which publish their quality data voluntarily, extend their market shares after relative to before publishing the quality data - compared to such hospitals that do not publish their quality data. Second: in the group of the publishing hospitals, hospitals with a higher than average quality increased their market shares after relative to before the adoption of the report card - compared to hospitals with a lower than average quality. Third: hospitals with quality below average are basically chosen by patients living nearby and not by those with a higher travelling distance. Based on these finding decision makers in hospitals have strong incentives (i) to make quality information publicly available and (ii) to keep their quality scores high.

Abstract

Long waiting times are a common feature and a major concern in many public health care systems. They are often characterized as inefficient because they are a burden to patients without generating any gains for providers. There is an ongoing debate in Germany regarding the preferential treatment given to private health insurance (PHI) holders while statutory health insurance (SHI) holders face continuously increasing waiting times. In order to tackle this problem in the outpatient sector, Germany initiated a reform in 2015 which was aimed at providing SHI holders with appointments within an acceptable time frame. We exploit longitudinal experimental data to examine waiting times for six elective outpatient treatments in Germany for PHI and SHI holders before and after the reform. We find a considerable difference in waiting times favoring private patients. For SHI holders, waiting times remained stable over time (27.5 days in 2014, 30.7 days in 2016, Δ 3.2 days, p-value=0.889) while PHI holders experienced a significant improvement (13.5 days in 2014; 7.8 days in 2016; Δ 5.7 days, p-value=0.002). The results indicate that even after the reform there is still an unequal access to elective outpatient treatment depending on the patient’s insurance status.