Browsing by Subject "Krankenversicherung"

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    Economic problems of health insurance : reforms and competition
    (2016) Lange, Renate; Schiller, Jörg
    Although most modern societies agree that everyone should receive adequate access to medical treatment, health care systems worldwide vary greatly in terms of financing of health care costs, the provision of medical services, and regulatory aspects. Rising costs, economic downturns, and the demographic development have embraced the call for change particularly with regard to financing of health care costs and access to health insurance. Most health care systems have developed historically, but underwent fundamental changes as a consequence of policy decisions and reforms. Looking back on recent health reforms in the U.S. and Germany two divergent trends can be observed: Over the last two decades, German Statutory Health Insurance (SHI) primarily experienced benefit cuts and had to implement economic incentives and market-based instruments to a solidary-based social security model in order to overall contain costs. At the same time, recent health reforms in the U.S. have shown that a solely market-based health insurance system is hardly consistent with modern society’s ideas on fairness and distributive justice. Furthermore, the exclusion of large parts of the population from seeking health insurance as a result of high premiums is not only associated with high costs and negative effects (even for those holding insurance coverage), but overall seen as highly inefficient. This thesis aims to draw a comprehensive picture of economic problems of health insurance and, thereby, assesses economic goals and analyzes effects of recent health reforms in the two historically grown very different health insurance systems of Germany and the U.S. More specifically, three research questions will be addressed: First, looking at the demand for supplemental health insurance (SuppHI) in the aftermath of benefit reductions in German SHI, it investigates what factors drive the demand for SuppHI and what are possible sources of selection. Furthermore, this thesis offers new insights on what the two health insurance systems can learn and take over from each other. In this context, it discusses how new trends in health insurance in the U.S. (i.e. Health Savings Accounts (HSAs)) could be implemented in German SHI. The third focus of this thesis is on the mutual interdependence of public and private health insurance markets. Analyzing financial data of private health insurers in the U.S., it looks into the question of how premiums in Private Health Insurance (PHI) are affected by public health insurance programs (i.e. Medicaid).
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    Publication
    Essays on long-term care and health insurance
    (2018) Schreckenberger, Christopher Karl Ludwig; Schiller, Jörg
    This thesis contributes to the literature on the impact of two individual options that may help to alleviate the financial pressure on the public sector with respect to health and long-term care expenditures. A particular focus is on the German health insurance and long-term care insurance (LTCI) system. The first option refers to the shifting of LTCI and health insurance coverage from a public system to markets for voluntary private health insurance (VPHI) and private LTCI. These private insurance markets may suffer from inefficiencies due to asymmetric information and selection effects, such as adverse selection. Hence, three papers in this thesis analyze selection effects in markets for VPHI and private LTCI. The first paper (chapter 2) reviews the empirical work on asymmetric information and related selection effects in markets for private LTCI and in the U.S. market for Medigap insurance. After providing an overview of the existence of selection effects in these markets, the review examines the evidence on several potential sources of selection. Regarding the latter, a focus is on the role of private information that individuals have on their risk type, on the role of the individual’s risk preferences and of sociodemographic characteristics. Following the review, two empirical papers analyze selection effects in the German markets for complementary private LTCI (chapter 3) and for supplemental dental insurance (chapter 4). Both markets have in common that they provide voluntary private insurance coverage for residual out-of-pocket expenditure risks not covered by statutory LTCI or health insurance in Germany. In addition, the ex-ante premium differentiation is rather limited in these markets. This makes these markets prone to selection effects. Using a large dataset on more than 98,000 individuals from a German private insurance company, the findings in chapter 3 suggest that advantageous selection is the dominating type of selection in the German market for complementary private LTCI. Examining potential drivers for selection, the analysis indicates that the occupation as well as the residential location are observable characteristics that are not used for pricing, but that contribute to advantageous selection through the socioeconomic status. The holding of supplemental health insurance policies is another observable attribute that affects the selection behavior. Analyzing the selection behavior within a dynamic framework, the analysis shows that the uptake and the cancellation of LTCI policies are associated with changes in health insurance payouts. Moreover, individuals with financial problems and with a lower socioeconomic status are more likely to drop complementary LTCI coverage. Based on survey data from the Healthcare Monitor of the Bertelsmann Stiftung, the findings in chapter 4 do not reveal a significant correlation between insurance coverage and risk in the market for supplemental dental insurance in Germany. Since one possible explanation for this finding is heterogeneous selection leading to an offsetting of adverse and advantageous selection, a large set of potential sources of selection effects is tested. The results indicate that the holding of other supplemental health insurance policies is a main driver for advantageous selection in this market. The findings in this chapter provide solid evidence that this insurance market suffers from asymmetric information and selection effects even though the correlation between insurance coverage and risk is not statistically significant. Instead of shifting insurance coverage to a private insurance system, another option to alleviate the financial burden in a public health insurance system, which is analyzed in this thesis, refers to the promotion of preventive health care. Specifically, the fourth paper (chapter 5) empirically examines the effectiveness of a nationwide population-based skin cancer screening (SCS) program that was implemented in Germany in 2008. To this end, panel data from 2000 to 2013 of the Eurostat database on subregions in 22 European countries are exploited. Using fixed effects methods, the results show a positive and robust effect of the German SCS program on the diagnosis rate for malignant skin neoplasms, but no significant impact on the melanoma mortality rate. The former suggests that this program is effective in terms of an increased diagnosis rate for malignant skin neoplasms and may therefore contribute to an improved detection of skin cancer at an early stage.