Browsing by Subject "Selektion"

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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).
The economics of elderly care
(2015) Bauer, Jan Michael; Sousa-Poza, Alfonso
Longer life expectancy and low fertility rates increase the share of elderly among the population of most industrialized countries. This demographic change affects the economy and the society and is most likely to proceed in the future. Therefore, policy makers and families need to be aware of the implications associated with an aging population. One particularly great challenge comes with the rising number of fragile elderly people, for which most countries are currently unable to provide sufficient care solutions. Germany, for instance, is facing a constantly rising share of people in need that mostly receive informal care from friends and family. Public support promotes these informal care arrangements (§3 SGB XI) and endorses care receivers to remain in their domestic environment. Even though such informal care arrangements are preferred by most families, caregiving can have a large impact on the caregiver’s life. Policy makers need to measure and incorporate these outcomes in order to provide suitable aid for caring families and, thereby, ensuring sustainable and dignified population aging. This dissertation consists of three academic papers and contributes to the topic in several ways: the first paper reviews the recent literature on the effects of informal caregiving on the caregiver and, thereby, assesses the opportunity costs associated with informal care provision. Further, we evaluated the methodology that is commonly used and identify certain risk groups as well as arrangements that are particularly burdensome. The second paper takes a specific look at the subjective well-being of caregivers in Germany and analyzes effects associated with providing care. In contrast to most prior studies, the paper uses large population-based longitudinal data, accounts for unobserved heterogeneity, and estimates the relationship with different methodologies. The paper further values well-being losses monetarily, which allows a comparison to formal care alternatives. The third paper provides new insights on individual selection behavior in the market for supplemental health insurances. This is an increasingly popular way to insure against long-term care needs, a risk not fully covered despite a statutory long-term care insurance. Private insurance markets are fragile in the presences of asymmetric information and, therefore, might not be a sustainable solution to cover the increasing risks of an aging society. We developed an innovative approach to disentangle different selection behaviors in a heterogeneous sample and identify asymmetric information exemplarily for the market of supplemental dental insurance, despite no risk-coverage correlation for the aggregated sample.