IDEAS home Printed from https://ideas.repec.org/a/spr/eujhec/v20y2019i8d10.1007_s10198-019-01086-7.html
   My bibliography  Save this article

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
    as

    Download full text from publisher

    File URL: http://link.springer.com/10.1007/s10198-019-01086-7
    File Function: Abstract
    Download Restriction: Access to the full text of the articles in this series is restricted.
    File URL: https://libkey.io/10.1007/s10198-019-01086-7?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    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.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Reif, Simon & Schubert, Sabrina & Wambach, Achim, 2024. "Reformvorschlag für einen nachhaltigen Risikostrukturausgleich," ZEW policy briefs 03/2024, ZEW - Leibniz Centre for European Economic Research.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Camilo Cid & Randall P. Ellis & Verónica Vargas & Juergen Wasem & Lorena Prieto, 2015. "Global Risk-Adjusted Payment Models," Boston University - Department of Economics - Working Papers Series wp2015-021, Boston University - Department of Economics.
    2. Thomson, Sarah & Busse, Reinhard & Crivelli, Luca & van de Ven, Wynand & Van de Voorde, Carine, 2013. "Statutory health insurance competition in Europe: A four-country comparison," Health Policy, Elsevier, vol. 109(3), pages 209-225.
    3. Jonas B. Pendzialek & Dusan Simic & Stephanie Stock, 2017. "Measuring customer preferences in the German statutory health insurance," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(7), pages 831-845, September.
    4. Sant’Anna, Pedro H.C. & Zhao, Jun, 2020. "Doubly robust difference-in-differences estimators," Journal of Econometrics, Elsevier, vol. 219(1), pages 101-122.
    5. Trojanek, Radoslaw & Huderek-Glapska, Sonia, 2018. "Measuring the noise cost of aviation – The association between the Limited Use Area around Warsaw Chopin Airport and property values," Journal of Air Transport Management, Elsevier, vol. 67(C), pages 103-114.
    6. Picarelli, Nathalie, 2016. "Who really benefits from export processing zones? Evidence from Nicaraguan municipalities," Labour Economics, Elsevier, vol. 41(C), pages 318-332.
    7. Christophe Loussouarn & Carine Franc & Yann Videau & Julien Mousquès, 2021. "Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities," Health Economics, John Wiley & Sons, Ltd., vol. 30(3), pages 680-698, March.
    8. Pablo Lavado & Gonzalo Rivera, 2016. "Identifying Treatment Effects with Data Combination and Unobserved Heterogeneity," Working Papers 79, Peruvian Economic Association.
    9. Haiyang Lu & Peng Nie & Alfonso Sousa-Poza, 2021. "The Effect of Parental Educational Expectations on Adolescent Subjective Well-Being and the Moderating Role of Perceived Academic Pressure: Longitudinal Evidence for China," Child Indicators Research, Springer;The International Society of Child Indicators (ISCI), vol. 14(1), pages 117-137, February.
    10. Schmid, Christian P.R. & Beck, Konstantin, 2016. "Re-insurance in the Swiss health insurance market: Fit, power, and balance," Health Policy, Elsevier, vol. 120(7), pages 848-855.
    11. James Roumasset & Christopher Wada, 2012. "The Economics of Groundwater," Working Papers 201211, University of Hawaii at Manoa, Department of Economics.
    12. Colin Green & Ole Henning Nyhus & Kari Vea Salvanes, "undated". "How does testing young children influence educational attainment and well-being?," Working Paper Series 19422, Department of Economics, Norwegian University of Science and Technology.
    13. Eliason, Marcus, 2011. "Assistant and auxiliary nurses in crisis times: earnings and employment following public sector job loss in the 1990s," Working Paper Series 2011:1, IFAU - Institute for Evaluation of Labour Market and Education Policy.
    14. Dröes, Martijn I. & Koster, Hans R.A., 2016. "Renewable energy and negative externalities: The effect of wind turbines on house prices," Journal of Urban Economics, Elsevier, vol. 96(C), pages 121-141.
    15. Torsten Persson & Guido Tabellini, 2007. "The growth effect of democracy: Is it heterogenous and how can it be estimated?," Working Papers 322, IGIER (Innocenzo Gasparini Institute for Economic Research), Bocconi University.
    16. Fresenbet Zeleke & Girma T. Kassie & Jema Haji & Belaineh Legesse, 2021. "Would Market Sheds Improve Market Participation and Earnings of Small Ruminant Keepers? Evidence from Ethiopia," Journal of Agricultural Economics, Wiley Blackwell, vol. 72(2), pages 470-485, June.
    17. Chunrong Ai & Oliver Linton & Kaiji Motegi & Zheng Zhang, 2021. "A unified framework for efficient estimation of general treatment models," Quantitative Economics, Econometric Society, vol. 12(3), pages 779-816, July.
    18. Adam Wagstaff & Magnus Lindelow, 2007. "Progressivity in the financing of decentralized government health programs: a decomposition," Health Economics, John Wiley & Sons, Ltd., vol. 16(11), pages 1271-1275.
    19. van Vuuren, Aico, 2022. "Is there a diminishing value of urban amenities as a result of the Covid-19 pandemic?," Working Papers in Economics 818, University of Gothenburg, Department of Economics.
    20. Eugster, Patrick & Sennhauser, Michèle & Zweifel, Peter, 2010. "Capping risk adjustment?," Journal of Health Economics, Elsevier, vol. 29(4), pages 499-507, July.

    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

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:spr:eujhec:v:20:y:2019:i:8:d:10.1007_s10198-019-01086-7. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Sonal Shukla or Springer Nature Abstracting and Indexing (email available below). General contact details of provider: http://www.springer.com .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.