Browsing by Subject "Gesundheitsökonomie"

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    Essays in health economics
    (2018) Kaiser, Micha; Sousa-Poza, Alfonso
    In economic theory a lot of attention is given to the understanding and modelling of consumption decisions of individuals. Usually, most models assume that individuals consume different markets goods and maximize their utility with respect to certain constraints. These constraints can be of various kinds. Besides monetary constraints health related constraints are vitally important during the maximization process of individuals. In such a paradigm, individuals would therefore benefit indirectly from being in a good health state, since this would imply that they are less constrained and could therefore shift their individual utility to a higher level. Moreover, health can also be treated as a good itself. Such an approach would assign a direct effect of different health states to an individuals utility rather than incorporating health states by including them as a source for binding constraints. Apart from the different strategies in modelling the consumption decisions, both ways of thinking have in common that the achievement as well as the maintenance of a good health state is – to some extent - a necessary condition to foster the utility maximization process. Additionally, health outcomes of individuals are highly sensitive to economic circumstances and different policy interventions. For instance, a change in the individuals income will lead to an adjustment of the optimal consumption decision and therefore also to an adjustment of the health outcome (either in a direct or indirect way). Therefore a profound understanding of the impact of changes in economic and political processes helps to assess their effects on the health outcomes of individuals. Hence, this thesis investigates the impact of different economic factors and policy interventions on health. In particular, the thesis contributes to the literature in the following way: Chapter two uses 22 years of data from the German Socio-Economic Panel and information on plant closures to investigate the effects of unemployment on four indicators of unhealthy lifestyles: diet, alcohol consumption, smoking, and (a lack of) physical activity. The main goal is to assess possible causal effects of unemployment on risky behaviors. In fact, in contrast to much of the existing literature the empirical identification strategy used in this analysis, is able to clearly identify exogenous effect and therefore avoids endogeneity, which may result from reversed causality. The main results provide little evidence that unemployment gives rise to unhealthy lifestyles. Chapter three evaluates the relation between preschool care and the well-being of children and adolescents in Germany by using data from the German Health Interview and Examination Survey of Children and Adolescents. Analyzing this relationship is important to provide conclusive knowledge for parents as well as policy-makers due to several reasons. While parents are interested in providing the best health outcomes for their children, policy-makers need to balance a possible trade-off between economic as well as social costs and benefits related to preschool care. Additionally, the chapter examines differences in outcomes based on child socioeconomic background by focusing on the heterogeneous effects for migrant children. The findings suggest that children who have experienced child care have a slightly lower well-being overall. For migrant children, however, the outcomes indicate a positive relation. The fourth chapter analyzes how a nationwide population-based skin cancer screening program (SCS) implemented in Germany in 2008 has impacted the number of hospital discharges following malignant skin neoplasm diagnosis and the malignant melanoma mortality rate per 100,000 inhabitants. Therefore, panel data from the Eurostat database, which covers subregions in 22 European countries is analyzed for the years 2000-2013. By using fixed-effects methods, the causal relationship between the skin cancer screening program and the change in diagnosis and mortality rates are identified and a policy implication is derived. While the results indicate that Germany’s nationwide SCS program is effective in terms of a higher diagnosis rate for malignant skin neoplasms and thus may contribute to an improvement in the early detection of skin cancer, there is no significant influence on the melanoma mortality rate. Chapter five analyzes how closely different income measures conform to Benford’s law, a mathematical predictor of probable first digit distribution across many sets of numbers. Because Benford’s law can be used to test data set reliability, a Benford analysis is applied to assess the quality of six widely used health related survey data sets. This is of particularly importance for health economists, since the majority of empirical work in this field relies on information from survey data. The findings indicate that although income generally obeys Benford’s law, almost all the data sets show substantial discrepancies from it, which can be interpreted as a strong indicator of reliability issues in the survey data. This result is confirmed by a simulation, which demonstrates that household level income data do not manifest the same poor performance as individual level data. This finding implies that researchers should focus on household level characteristics whenever possible to reduce observation errors.
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    Publication
    Essays in health economics
    (2023) Meng, Fan; Sousa-Poza, Alfonso
    As the global economy and healthcare evolve, subjective well-being is increasingly becoming a topic of interest in the field of health economics. In this dissertation, we try to investigate subjective well-being from two related aspects: obesity and marriage. Obesity is a global health crisis that has reached alarming proportions in recent years. Defined as an excessive accumulation of body fat, obesity has far-reaching implications for both individ- ual health and society as a whole. Its prevalence has steadily risen, with over 650 million adults worldwide classified as obese, according to data from the World Health Organization (WHO). This epidemic has led to a surge in obesity-related health problems, including diabetes, cardio- vascular disease, and certain types of cancer, making it a pressing concern for healthcare systems and policymakers. Estimates of the cost of obesity are an important basis for the development and evaluation of obesity-related policies. Previous studies have estimated the direct and indirect costs of obesity, but in addition to these, the intangible costs of obesity are also noteworthy. The intangi- ble costs of obesity are associated with a loss of well-being. In addition, obesity-related inequality may also combine with peer effects to lead to lower well-being in obese individuals. So, ignoring the intangible costs of obesity may lead to underestimating the benefits of obesity control policies. Marriage, without a doubt, is a major event in life. People from almost any socio-cultural back- ground consider marriage-related decisions such as whether to get married, when to get married, and with whom to get married. But nowadays, in increasingly countries around the world, mar- riage rates continue to decline and the age of first marriage continues to be delayed, so we sought to analyze whether these trends are related to marriage-related well-being. The contributions of each chapter are shown below: Chapter 2 uses SOEP 2002-2018 data and a life satisfaction-based compensation approach to quantify the intangible costs of overweight and obesity. Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany. Our results underscore how existing research into obesity’s economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger. Chapter 3 uses data from the German Socio-Economic Panel (GSOEP), investigates the changes in the BMI distribution and obesity inequality among German adults aged 18+ between 2002-2018 and estimates the relationship between obesity inequality and subjective well-being. The results show that the rise in obesity prevalence is mainly due to an overall rightward shift of the BMI distribution, accompanied by an increase in left skewness. Over the entire 16-year period, obe- sity inequality increased significantly, especially among females, those with low education levels, and low-income groups. The results also document a significant association between different measures of obesity inequality and subjective well-being, especially among women. Chapter 4 explores the trends in the subjective well-being (SWB) of never-married people (referenced with the married) and the factors that account for the gaps in SWB between never- married and married people. By employing a harmonized data from surveys conducted in six distinct countries, namely Australia (HILDA), South Korea (KLIPS), Russia (RLMS), Switzerland (SHP), Germany (SOEP), and the United Kingdom (BHPS and UKHLS), our analysis discerns a consistent and statistically significant association between never-married status and lower levels of life satisfaction, a relationship that has exhibited no substantial alteration over time. Particularly noteworthy is the discernible reduction in life satisfaction among never-married individuals in South Korea in comparison to their married counterparts. The thesis concludes with a short summary in chapter five.
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    Incentives in health care provision
    (2022) Weinert, Johanna Katharina; Schiller, Jörg
    The importance of finding ways to ensure high quality health care provision in a cost-effective and efficient way becomes a more and more pressing issue considering the challenges many economies currently face due to ageing populations, rising costs caused by advancements in medical technology or an increasing shortage in qualified personnel. Chapter 2 analyzes empirically how the introduction of a surgical suite governance document affects punctuality in first case of the day starts. Delays in first cases are an indicator for inefficiencies in operating room utilization. Because operating rooms constitute a major driver in hospitals’ operating costs, clinic management has a strong interest in incentivizing process efficiency. This analysis focuses on the implementation of a surgical suite governance document, which explicitly specifies the starting time of the first case of the day and formulates scheduling rules. First case punctuality is an easily observable and measurable performance indicator, which is associated with only minor tracking efforts and consequently low costs. The analysis uses a quasi-experimental setting, which arose from the lagged implementation of an identical governance document in two different hospital sites belonging to the same hospital group. To assess the effect of the governance document empirically , a difference-in-difference estimation approach is implemented. Results indicate that the introduction of a surgical suite governance document is associated with significant reductions in first case delays. In conclusion, a surgical suite governance document seems to offer a promising tool to incentivize health care workers to use costly resources like surgery capacities more efficiently. Chapter 3 analyzes the effects of a reimbursement change - from fee-for-service paid out-of-pocket (OOP-FFS) to a capitation fee per patient - on health service provision. This change was part of a selective contract in outpatient pediatric care introduced by a large German sickness fund in 2014. The present analysis aims at deriving further insights on how reimbursement affects service provision and at offering guidelines for future designs of selective contracts. To reflect the special features of the analyzed selective contract, namely that incentives change for both the pediatricians and the patients simultaneously, a theoretical model is set up to derive a testable hypothesis. The model predicts that given pediatricians are not only monetarily incentivized (but also sufficiently concerned about patients’ well-being) and that costs associated with screening provision are relatively small, reimbursement change from OOP-FFS to capitation will induce an increase in service provision. Using a generalized difference-in-difference approach, the theoretically derived hypothesis is tested empirically. Results indicate that the change from fee-for-service paid out-of-pocket to a capitation fee per patient did lead to a significant increase in provided screenings as the number of diagnoses more than doubles for pediatricians enrolled in the program. These findings indicate that physicians are not solely driven by monetary incentives and that capitation per patient offers a valuable tool to ensure cost control yet simultaneously ensure effective health care provision. Chapter 4 examines to which extent policymakers are able to incentivize hospitals to increase quality provision by actively fostering the link between performance indicator reporting and hospitals’ reputation. A better understanding of policymakers influence on quality incentives is crucial as empirical findings show that hospitals vary with respect to quality provision, implying that potential for improvements exists at least for some service providers. By fostering the link between hospitals’ outcome-based performance indicators such as mortality-, readmission- or complication rates and reputation, policymakers are able to affect hospitals’ market share and thereby ultimately hospitals’ incentives for quality provision. Ways to strengthen the aforementioned link are manifold, e.g. by raising awareness about the existence and importance of hospital performance reports or by improving populations’ health literacy to ensure that patients are able to decode the information provided by performance indicators correctly. The main finding is that a strengthened link between performance indicators’ realization and hospitals’ reputation does not necessarily result in stronger incentives for quality provision. In the case where the degree of competition is sufficiently low and the costs associated with quality provision are sufficiently high, an intensified link between performance indicators and reputation induces a decrease in quality provision. If the opposite is true, strengthening the link between performance indicators’ realization and hospitals’ reputation always induces an increase in quality provision.