The article aims at analyzing a particular occupational privilege of employees, commonly referred
to as a benefitspackage. This social privilege is considered a real social and legal phenomenon by
a large number of academics. This is because no legal regulations on the privatization and commer
cialization of Polish companies actually imposed it. The origin of this specific privilege lies in the
pragmatic attitude of employees to the process of privatization of companies and selling their stocks
to strategic investors. This type of agreements was supposed to
Jahrbücher f. Nationalökonomie u. Statistik (Lucius & Lucius, Stuttgart 2007) Bd. (Vol.) 227/5+6
Zur Dualität von GKV und PKV
The Future of Private and Public Health Insurance in Germany
Von Klaus-Dirk Henke, Berlin∗
JEL I11, I18
Health insurance, Social Security, Competition Strengthening Act 2007, benefitpackage, adverse selec-
tion, health care.
The center of the article deals with the future of the public and private health insurance system
in Germany. It analyses therefore both the statutory fund system and the private health insu-
Background: Diabetes is a leading cause of end stage renal disease (ESRD), which impacts on treatment costs and patients’ quality of life. Microalbuminuria screening in patients with diabetes as an early intervention is beneficial in slowing the progression of diabetic nephropathy.
Objectives: We aimed to assess the cost-effectiveness of annual microalbuminuria screening in type 2 diabetic patients.
Methods: We compared screening by urine dipsticks with a “do nothing” scenario. To replicate the natural history of diabetic nephropathy, a Markov model based on a simulated cohort of 10,000 45-year-old normotensive diabetic patients was utilized. We calculated the cost and quality of life gathered from a cross-sectional survey. The costs of dialysis were derived from The National Health Security Office (NHSO). We also calculated the incremental cost-effectiveness ratio (ICER) for lifetime with a future discount rate of 3%.
Results: The ICER was 3,035 THB per quality-adjusted life year (QALY) gained. One-way and probabilistic sensitivity analyses showed that all ICERs were less than the Thai Gross Domestic Product (GDP) per capita (150,000 THB in 2011) based on World Health Organization’s suggested criteria.
Conclusions: Annual microalbuminuria screening using urine dipsticks in type 2 diabetic patients is very costeffective in Thailand based on World Health Organization’s recommendations. This finding has corroborated the benefit of this screening in the public health benefit package.
In this paper, I estimate country-level efficiency using a newer order-m estimator where I condition efficiency estimates on secondary environmental variables. This allows me to identify which variables influence the effectiveness of a healthcare delivery system. I find that not controlling for secondary environmental variables leads to the average OECD country being 11% inefficient; after controlling for demographics and economic (social protection) environmental variables, inefficiency reduces to 7% (5%). This provides evidence that a substantial part of the inefficiencies of a healthcare system is related to demographics, socioeconomics, and the structure of the healthcare delivery system. Using the second-stage results, I find lower healthcare spending, both as a percent of GDP and total out-of-pocket, as well as more of the population covered by public health insurance, is related to better efficiency. Lower fertility rates, lower immigration rates, higher incomes, and lower pharmaceutical doses are also consistent with better healthcare efficiency. Lastly, a healthcare system that provides a basic benefits package but allows for purchase of private health insurance, with moderate gatekeeping and flexibility to increase the budget for healthcare through public and private financing, are the most efficient healthcare systems.
. Retrieved from: http://dx.doi.org/10.1787/223883627348 . Luci-Greulich, A., Thévenon, O. (2013). The Impact of Family Policies on Fertility Trends in Developed Countries. European Journal of Population, 29(2), 387-416. OECD, (2011). The Balance of Family Policy Tools – BenefitPackages, Spending by Age and Families with Young Children. In Doing Better for Families, OECD Publishing, Paris, 55-88. Retrieved from: https://doi.org/10.1787/9789264098732-4-en . OECD, (2018a). Fertility rates (indicator). Retrieved from: https://data.oecd.org/pop/fertility-rates.htm . OECD
births since 2009 [ 6 ], it is not clear how the universal coverage scheme (UCS) in Thailand—established in 2003—which allowed the country to achieve UHC— contributed to sustainability or any improvement of the outcomes. Under the UCS, resources allocated for MCH aimed to cover costs of disorder prevention and health promotion under benefitpackages for family planning, antenatal care for pregnant women, and wellbaby clinics. This care could be provided at the primary care level, in health centers, or in public and private hospitals. In addition, the coverage included
appraisal and make coverage
decision. Providers, professionals and patients also have a legal right to appeal against the
4 . PROVISION AND DELIVERY OF SERVICES
In Hungary, the health care system is based on a compulsory national insurance model.
Universal coverage is assured through a combination of mandatory social insurance for
the working population and guaranteed coverage for the retired and people under the po-
verty level. Basic benefitpackages have not been defined yet, and decisions on coverage
related issues are made on ad hoc basis
plans operating in MA; by 2003 there were only 146 plans. But once the Medicare Modernization Act began subsidizing private plans to enter the market both the number of plans and the enrollment in MA rebounded. 3 How MA Works Now Currently, MA plans are paid a fixed premium in order to provide the Medicare Part A and Part B (and sometimes D) 1 MA plans are given the option of offering Medicare Part D benefits but are not required to do so. If a MA plan chooses to cover Part D then the bid that plan submits to CMS includes that cost. benefitpackages, which gives them
depends on both price
and the content of coverage. Lower price leads to increased coverage
if the content of the benefitspackage is held constant, but the benefitspackage is not necessarily valuable if its characteristics are also
In her empirical work, Glied examines what features of insurance
are most likely to maximize enrollment by the uninsured. She con-
3Cutler and Garber: Introduction to Frontiers in Health Policy Research, Volume 6
cludes that the uninsured are likely to prefer front-end coverage with
a low benefit maximum to
the part of health-care providers.
Why should higher-income workers be
expected to pay for more of their retirement
health care than lower-income workers must?
With the current financing arrangement, high-
income retirees already pay more payroll taxes
and income taxes in support of Medicare than
do lower-income retirees, but they receive an
insurance benefitpackage with identical cover-
age. Recent research suggests that even though
higher-income retirees live longer and thus re-
ceive more from Medicare over their lifetimes,
the program is still