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What accounts for the regional differences in the utilisation of hospitals in Germany?


  • Boris Augurzky
  • Thomas Kopetsch
  • Hendrik Schmitz



There are huge regional variations in the utilisation of hospital services in Germany. In 2007 and 2008 the states of Hamburg and Baden-Württemberg had on average just under 38 % fewer hospitalisations per capita than Saxony-Anhalt. We use data from the DRG statistics aggregated at the county level in combination with numerous other data sources (e.g. INKAR Database, accounting data from the National Association of Statutory Health Insurance Physicians (KBV), Federal Medical Registry, Germany Hospital Directory, population structure per county) to establish the proportion of the observed regional differences that can be explained at county and state levels. Overall we are able to account for 73 % of the variation at state level in terms of observable factors. By far the most important reason for the regional variation in the utilisation of in-patient services is differences in medical needs. Differences in the supply of medical services and the substitutability of outpatient and inpatient treatment are also relevant, but to a lesser extent. Copyright Springer-Verlag 2013

Suggested Citation

  • Boris Augurzky & Thomas Kopetsch & Hendrik Schmitz, 2013. "What accounts for the regional differences in the utilisation of hospitals in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 615-627, August.
  • Handle: RePEc:spr:eujhec:v:14:y:2013:i:4:p:615-627
    DOI: 10.1007/s10198-012-0407-6

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    References listed on IDEAS

    1. David Prieto & Santiago Lago-Peñas, 2012. "Decomposing the determinants of health care expenditure: the case of Spain," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(1), pages 19-27, February.
    2. Joseph J. Doyle, 2011. "Returns to Local-Area Health Care Spending: Evidence from Health Shocks to Patients Far from Home," American Economic Journal: Applied Economics, American Economic Association, vol. 3(3), pages 221-243, July.
    3. Stefan Felder & Harald Tauchmann, 2013. "Federal state differentials in the efficiency of health production in Germany: an artifact of spatial dependence?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 21-39, February.
    4. Kemptner, Daniel & Jürges, Hendrik & Reinhold, Steffen, 2011. "Changes in compulsory schooling and the causal effect of education on health: Evidence from Germany," Journal of Health Economics, Elsevier, vol. 30(2), pages 340-354, March.
    5. Louise Sheiner & David M. Cutler, 1999. "The Geography of Medicare," American Economic Review, American Economic Association, vol. 89(2), pages 228-233, May.
    6. Andrew J. Rettenmaier & Zijun Wang, 2012. "Regional variations in medical spending and utilization: a longitudinal analysis of US Medicare population," Health Economics, John Wiley & Sons, Ltd., vol. 21(2), pages 67-82, February.
    7. Oliver Reich & Cornelia Weins & Claudia Schusterschitz & Magdalena Thöni, 2012. "Exploring the disparities of regional health care expenditures in Switzerland: some empirical evidence," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(2), pages 193-202, April.
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    Cited by:

    1. Augurzky, Boris & Dördelmann, Sandra & Pilny, Adam, 2016. "Überblick Krankenhausstrukturen Rheinland-Pfalz und Saarland," RWI Projektberichte, RWI - Leibniz-Institut für Wirtschaftsforschung, number 149878.
    2. repec:eee:hepoli:v:122:y:2018:i:3:p:293-300 is not listed on IDEAS
    3. Tugba Büyükdurmus & Thomas Kopetsch & Hendrik Schmitz & Harald Tauchmann, 2017. "On the interdependence of ambulatory and hospital care in the German health system," Health Economics Review, Springer, vol. 7(1), pages 1-19, December.
    4. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles, ZBW - Leibniz Information Centre for Economics, pages 305-320.
    5. Augurzky, Boris & Beivers, Andreas & Straub, Niels & Veltkamp, Caroline, 2014. "Erarbeitung von Umsetzungsvorschlägen der Positionen der Ersatzkassen zur Krankenhausplanung: Vorläufiger Endbericht zum Forschungsvorhaben des Verbandes der Ersatzkassen e. V. (vdek)," RWI Projektberichte, RWI - Leibniz-Institut für Wirtschaftsforschung, number 111481.

    More about this item


    Hospital utilisation; Regional differences; Substitutability; I11; I18;

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health


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