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Sources of regional variation in healthcare utilization in Germany

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  • Salm, Martin
  • Wübker, Ansgar

Abstract

We examine sources of regional variation in ambulatory care utilization in Germany. We exploit patient migration to examine which share of regional variation in ambulatory care utilization can be attributed to demand factors and to supply factors, respectively. Based on administrative claim-level data we find that regional variation can be overwhelmingly explained by patient characteristics. Our results contrast with previous results for other countries, and they suggest that institutional rules in Germany successfully constrain supply-side variation in ambulatory care use between German regions for most patients. Furthermore, we find that both demographics and other patient characteristics substantially contribute to regional variation and that causes of regional variation vary when comparing different regions within Germany.

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  • Salm, Martin & Wübker, Ansgar, 2020. "Sources of regional variation in healthcare utilization in Germany," Journal of Health Economics, Elsevier, vol. 69(C).
  • Handle: RePEc:eee:jhecon:v:69:y:2020:i:c:s016762961830866x
    DOI: 10.1016/j.jhealeco.2019.102271
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    Cited by:

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    3. Shan Huang & Hannes Ullrich, 2021. "Physician Effects in Antibiotic Prescribing: Evidence from Physician Exits," Discussion Papers of DIW Berlin 1958, DIW Berlin, German Institute for Economic Research.
    4. Michael Berger & Thomas Czypionka, 2021. "Regional medical practice variation in high-cost healthcare services," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 22(6), pages 917-929, August.
    5. Feras Kasabji & Alaa Alrajo & Ferenc Vincze & László Kőrösi & Róza Ádány & János Sándor, 2020. "Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary," IJERPH, MDPI, vol. 17(23), pages 1-17, December.
    6. Jakub Cerveny & Jan C. van Ours, 2022. "Long-term returns to local health-care spending," Tinbergen Institute Discussion Papers 22-072/V, Tinbergen Institute.
    7. Wende, Danny & Kopetsch, Thomas & Richter, Wolfram F., 2020. "Planning health care capacities with a gravity equation," Ruhr Economic Papers 888, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    8. Naimi Johansson & Mikael Svensson, 2022. "Regional variation in prescription drug spending: Evidence from regional migrants in Sweden," Health Economics, John Wiley & Sons, Ltd., vol. 31(9), pages 1862-1877, September.
    9. Cavazza, Marianna & Vecchio, Mario Del & Fattore, Giovanni & Fenech, Lorenzo, 2023. "Geographical variation in the use of private health insurance in a predominantly publicly-funded system," Health Policy, Elsevier, vol. 130(C).
    10. Berger, Michael & Czypionka, Thomas, 2021. "Regional medical practice variation in high-cost healthcare services: evidence from diagnostic imaging in Austria," LSE Research Online Documents on Economics 112952, London School of Economics and Political Science, LSE Library.
    11. Shan Huang & Hannes Ullrich, 2023. "Provider effects in antibiotic prescribing: Evidence from physician exits," Berlin School of Economics Discussion Papers 0018, Berlin School of Economics.
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    More about this item

    Keywords

    Healthcare spending; Regional variation; Germany;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • H51 - Public Economics - - National Government Expenditures and Related Policies - - - Government Expenditures and Health

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