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Economic impact of disease prevention in a morbidity-based financing system: does prevention pay off for a statutory health insurance fund in Germany?

Author

Listed:
  • Ines Weinhold

    (WIG2 Scientific Institute for Health Economics and Health System Research)

  • Christian Schindler

    (WIG2 Scientific Institute for Health Economics and Health System Research)

  • Nils Kossack

    (WIG2 Scientific Institute for Health Economics and Health System Research)

  • Benjamin Berndt

    (WIG2 Scientific Institute for Health Economics and Health System Research)

  • Dennis Häckl

    (WIG2 Scientific Institute for Health Economics and Health System Research)

Abstract

Preventable chronic diseases account for the greatest burden in the German health system and statutory health insurance (SHI) funds play a crucial role in implementing and financing prevention strategies. On the contrary, the morbidity-based scheme to distribute financial resources from the Central Reallocation Pool among the different sickness funds may counteract efforts of effective prevention from an economic perspective. We assessed financial impacts of prevention from a sickness funds perspective in a retrospective controlled study. Claims data of 6,247,275 persons were analyzed and outcomes between two propensity-matched groups (n = 852,048) of prevention users and non-users were compared in a 4-year follow-up. Using a difference-in-differences approach, we analyzed healthcare expenditures, the development of morbidity, financial transfers from the Central Reallocation Pool, and contribution margins. The group of prevention users develops less morbidity (incidences and disease aggravations) compared to the control group. Healthcare expenditures increase in both groups within 4 years, whereas the increase is lower for prevention users compared to non-users (€568.04 vs. €640.60, p

Suggested Citation

  • Ines Weinhold & Christian Schindler & Nils Kossack & Benjamin Berndt & Dennis Häckl, 2019. "Economic impact of disease prevention in a morbidity-based financing system: does prevention pay off for a statutory health insurance fund in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(8), pages 1181-1193, November.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:8:d:10.1007_s10198-019-01086-7
    DOI: 10.1007/s10198-019-01086-7
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    References listed on IDEAS

    as
    1. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    2. Alberto Abadie, 2005. "Semiparametric Difference-in-Differences Estimators," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 72(1), pages 1-19.
    3. Stephanie Stock & Björn Stollenwerk & Gabriele Klever-Deichert & Marcus Redaelli & Guido Büscher & Christian Graf & Klaus Möhlendick & Jan Mai & Andreas Gerber & Markus Lüngen & Karl Lauterbach, 2008. "Preliminary analysis of short term financial implications of a prevention bonus program: First results from the German statutory health insurance," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 53(2), pages 78-86, April.
    4. van de Ven, Wynand P. M. M. & Beck, Konstantin & Buchner, Florian & Chernichovsky, Dov & Gardiol, Lucien & Holly, Alberto & Lamers, Leida M. & Schokkaert, Erik & Shmueli, Amir & Spycher, Stephan & Van, 2003. "Risk adjustment and risk selection on the sickness fund insurance market in five European countries," Health Policy, Elsevier, vol. 65(1), pages 75-98, July.
    5. Augurzky, Boris & Reichert, Arndt R. & Schmidt, Christoph M., 2012. "The Effect of a Bonus Program for Preventive Health Behavior on Health Expenditures," Ruhr Economic Papers 373, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
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    More about this item

    Keywords

    Prevention; Healthcare financing; Incentives; Regulation; Competition;
    All these keywords.

    JEL classification:

    • I10 - Health, Education, and Welfare - - Health - - - General
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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