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Determinants of health care utilization by German sickness fund members - with application to risk adjustment

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  • Friedrich Breyer

    (University of Konstanz and DIW, Berlin)

  • Martin Heineck

    (University of Konstanz and DIW, Berlin)

  • Normann Lorenz

    (University of Konstanz and DIW, Berlin)

Abstract

In many countries, social health insurance systems are being reformed in favor of more competition among insurers, while premiums are community rated by regulation. The implicit incentives for insurers to engage in risk selection can only be curtailed using appropriate systems of risk-adjusted equalization payments among insurers. To develop these systems, predictors of individual utilization patterns have to be identified, e.g. via regression analysis using previous utilization data. In some countries such as Germany, such data are hardly ever available. In the early nineties, a number of sickness funds participated in an experiment in which individual utilization data were collected. Our data set covers more than 70 000 members of company sickness funds over a 5-year period. We analyze socio-demographic determinants of utilization which could be used as risk adjusters in a risk equalization scheme. Our results suggest that besides age and sex, the set of risk adjusters should include income, family status and a dummy for the last year of life. Copyright © 2002 John Wiley & Sons, Ltd.

Suggested Citation

  • Friedrich Breyer & Martin Heineck & Normann Lorenz, 2003. "Determinants of health care utilization by German sickness fund members - with application to risk adjustment," Health Economics, John Wiley & Sons, Ltd., vol. 12(5), pages 367-376.
  • Handle: RePEc:wly:hlthec:v:12:y:2003:i:5:p:367-376
    DOI: 10.1002/hec.757
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    References listed on IDEAS

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    1. van Barneveld, Erik M. & Lamers, Leida M. & van Vliet, René C. J. A. & van de Ven, Wynand P. M. M., 1998. "Mandatory pooling as a supplement to risk-adjusted capitation payments in a competitive health insurance market," Social Science & Medicine, Elsevier, vol. 47(2), pages 223-232, July.
    2. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
    3. van Doorslaer, Eddy & Wagstaff, Adam & Bleichrodt, Han & Calonge, Samuel & Gerdtham, Ulf-G. & Gerfin, Michael & Geurts, Jose & Gross, Lorna & Hakkinen, Unto & Leu, Robert E., 1997. "Income-related inequalities in health: some international comparisons," Journal of Health Economics, Elsevier, vol. 16(1), pages 93-112, February.
    4. Gerdtham, Ulf-G. & Johannesson, Magnus, 2000. "Income-related inequality in life-years and quality-adjusted life-years," Journal of Health Economics, Elsevier, vol. 19(6), pages 1007-1026, November.
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    Cited by:

    1. Asada, Yukiko & Kephart, George & Hurley, Jeremiah & Yoshida, Yoko & Smith, Andrea & Bornstein, Stephen, 2012. "The role of proximity to death in need-based approaches to health care," Health Policy, Elsevier, vol. 106(3), pages 291-302.
    2. Mathias Kifmann & Kerstin Roeder, "undated". "Premium Subsidies and Social Insurance: Substitutes or Complements?," Working Papers 2011/01, Hamburg Center for Health Economics, University of Hamburg.
    3. Robert Nuscheler & Thomas Knaus, 2005. "Risk selection in the German public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1253-1271.
    4. Timothy J. Layton & Randall P. Ellis & Thomas G. McGuire, 2015. "Assessing Incentives for Adverse Selection in Health Plan Payment Systems," Boston University - Department of Economics - Working Papers Series wp2015-024, Boston University - Department of Economics.
    5. Jacob Glazer & Thomas G. McGuire, 2006. "Contending with Risk Selection in Health Insurance Markets in Germany," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 7(s1), pages 75-91, May.
    6. Marc Saez & Carme Saurina & Germà Coenders & Sònia González-Raya, 2006. "Use of primary health care services according to the different degrees of obesity in the Girona Health Region, Spain," Health Economics, John Wiley & Sons, Ltd., vol. 15(2), pages 173-193.

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