IDEAS home Printed from https://ideas.repec.org/p/lue/wpaper/284.html
   My bibliography  Save this paper

Cost Containment and Managed Care: Evidence from German Macro Data

Author

Listed:
  • Andree Ehlert

    (Leuphana University of Lueneburg, Germany)

  • Dirk Oberschachtsiek

    (Leuphana University of Lueneburg, Germany)

  • Stefan Prawda

    (Leuphana University of Lueneburg, Germany)

Abstract

The major German health care reforms undertaken since the late 1990s resulted in the adoption of selective contracting mechanisms in a formerly sectorally separated health care system. These reforms marked the launch of managed care in Germany that is expected to yield both a higher quality of care and cost containment. We investigate if managed care had an in fluence on the structure of health care expenditure in Germany during the start-up phase of managed care from 2004 to 2008. We focus on pharmaceutical spending by statutory sickness funds (i.e. German law- enforced health insurance). We followed a macroeconomic evaluation approach based on a regional panel data set in contrast to previous research and were thus able to control for a comprehensive set of regional and demographic variables. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending.

Suggested Citation

  • Andree Ehlert & Dirk Oberschachtsiek & Stefan Prawda, 2013. "Cost Containment and Managed Care: Evidence from German Macro Data," Working Paper Series in Economics 284, University of Lüneburg, Institute of Economics.
    • Handle: RePEc:lue:wpaper:284
    as

    Download full text from publisher

    File URL: https://www.leuphana.de/fileadmin/user_upload/Forschungseinrichtungen/ifvwl/WorkingPapers/lue/pdf/wp_284_Upload.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Atella, Vincenzo, 2000. "Drug cost containment policies in Italy: are they really effective in the long-run?: The case of minimum reference price," Health Policy, Elsevier, vol. 50(3), pages 197-218, January.
    2. Joan Costa‐Font & Jordi Pons‐Novell, 2007. "Public health expenditure and spatial interactions in a decentralized national health system," Health Economics, John Wiley & Sons, Ltd., vol. 16(3), pages 291-306, March.
    3. Guillem López-Casasnovas & Marc Saez, 2007. "A multilevel analysis on the determinants of regional health care expenditure: a note," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(1), pages 59-65, March.
    4. Office of Health Economics, 2007. "The Economics of Health Care," For School 001490, Office of Health Economics.
    5. Croissant, Yves & Millo, Giovanni, 2008. "Panel Data Econometrics in R: The plm Package," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 27(i02).
    6. 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.
    7. Okunade, Albert A. & Suraratdecha, Chutima, 2006. "The pervasiveness of pharmaceutical expenditure inertia in the OECD countries," Social Science & Medicine, Elsevier, vol. 63(1), pages 225-238, July.
    8. 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.
    9. Parkin, David & McGuire, Alistair & Yule, Brian, 1987. "Aggregate health care expenditures and national income : Is health care a luxury good?," Journal of Health Economics, Elsevier, vol. 6(2), pages 109-127, June.
    10. Joseph P. Newhouse, 1977. "Medical-Care Expenditure: A Cross-National Survey," Journal of Human Resources, University of Wisconsin Press, vol. 12(1), pages 115-125.
    11. Baltagi, Badi H. & Li, Qi, 1995. "Testing AR(1) against MA(1) disturbances in an error component model," Journal of Econometrics, Elsevier, vol. 68(1), pages 133-151, July.
    12. Hitiris, Theo & Posnett, John, 1992. "The determinants and effects of health expenditure in developed countries," Journal of Health Economics, Elsevier, vol. 11(2), pages 173-181, August.
    13. Gerdtham, Ulf-G. & Jonsson, Bengt, 2000. "International comparisons of health expenditure: Theory, data and econometric analysis," Handbook of Health Economics, in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 1, pages 11-53, Elsevier.
    14. Baltagi, Badi H. & Li, Qi, 1991. "A joint test for serial correlation and random individual effects," Statistics & Probability Letters, Elsevier, vol. 11(3), pages 277-280, March.
    15. Schmitz, Hendrik, 2011. "Why are the unemployed in worse health? The causal effect of unemployment on health," Labour Economics, Elsevier, vol. 18(1), pages 71-78, January.
    16. Marisa Elena Domino & David S. Salkever, 2003. "Price elasticity and pharmaceutical selection: the influence of managed care," Health Economics, John Wiley & Sons, Ltd., vol. 12(7), pages 565-586, July.
    17. Gerdtham, Ulf-G. & Sogaard, Jes & Andersson, Fredrik & Jonsson, Bengt, 1992. "An econometric analysis of health care expenditure: A cross-section study of the OECD countries," Journal of Health Economics, Elsevier, vol. 11(1), pages 63-84, May.
    18. Luca Crivelli & Massimo Filippini & Ilaria Mosca, 2006. "Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons," Health Economics, John Wiley & Sons, Ltd., vol. 15(5), pages 535-541, May.
    Full references (including those not matched with items on IDEAS)

    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. Andree Ehlert & Dirk Oberschachtsiek, 2014. "Does managed care reduce health care expenditure? Evidence from spatial panel data," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 207-227, September.
    2. Di Matteo, Livio & Cantarero-Prieto, David, 2018. "The Determinants of Public Health Expenditures: Comparing Canada and Spain," MPRA Paper 87800, University Library of Munich, Germany.
    3. Błażej Łyszczarz, 2018. "Determinanty wydatków na zdrowie w gospodarstwach domowych w Polsce," Gospodarka Narodowa. The Polish Journal of Economics, Warsaw School of Economics, issue 1, pages 137-157.
    4. Badi H. Baltagi & Raffaele Lagravinese & Francesco Moscone & Elisa Tosetti, 2017. "Health Care Expenditure and Income: A Global Perspective," Health Economics, John Wiley & Sons, Ltd., vol. 26(7), pages 863-874, July.
    5. Muhammad Arshad Khan & Muhammad Iftikhar Ul Husnain, 2019. "Is health care a luxury or necessity good? Evidence from Asian countries," International Journal of Health Economics and Management, Springer, vol. 19(2), pages 213-233, June.
    6. Joan Costa‐Font & Marin Gemmill & Gloria Rubert, 2011. "Biases in the healthcare luxury good hypothesis?: a meta‐regression analysis," Journal of the Royal Statistical Society Series A, Royal Statistical Society, vol. 174(1), pages 95-107, January.
    7. Vandersteegen, Tom & Marneffe, Wim & Cleemput, Irina & Vereeck, Lode, 2015. "The impact of no-fault compensation on health care expenditures: An empirical study of OECD countries," Health Policy, Elsevier, vol. 119(3), pages 367-374.
    8. Héctor Bellido & Lorena Olmos & Juan Antonio Román-Aso, 2019. "Do political factors influence public health expenditures? Evidence pre- and post-great recession," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(3), pages 455-474, April.
    9. Clemente, Jesús & Lazaro, Angelina & Montanes, Antonio, 2016. "Public health expenditure in Spain: is there partisan behaviour?," MPRA Paper 69781, University Library of Munich, Germany.
    10. Livio Di Matteo & Thomas Barbiero, 2020. "Spend Less, Get More? Explaining Health Spending and Outcome Differences Between Canada and Italy," Review of Economic Analysis, Digital Initiatives at the University of Waterloo Library, vol. 12(4), pages 403-438, December.
    11. Niklas Potrafke, 2012. "Political cycles and economic performance in OECD countries: empirical evidence from 1951–2006," Public Choice, Springer, vol. 150(1), pages 155-179, January.
    12. Potrafke, Niklas, 2010. "The growth of public health expenditures in OECD countries: Do government ideology and electoral motives matter?," Journal of Health Economics, Elsevier, vol. 29(6), pages 797-810, December.
    13. Vitor Castro, 2017. "Pure, White and Deadly… Expensive: A Bitter Sweetness in Health Care Expenditure," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1644-1666, December.
    14. Yihua Yu & Li Zhang & Fanghua Li & Xinye Zheng, 2013. "Strategic interaction and the determinants of public health expenditures in China: a spatial panel perspective," The Annals of Regional Science, Springer;Western Regional Science Association, vol. 50(1), pages 203-221, February.
    15. Hartwig, Jochen, 2008. "What drives health care expenditure?--Baumol's model of 'unbalanced growth' revisited," Journal of Health Economics, Elsevier, vol. 27(3), pages 603-623, May.
    16. 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.
    17. Masayoshi Hayashi & Akiko Oyama, 2014. "Factor Decomposition of Inter-prefectural Health Care Expenditure Disparities in Japan," CIRJE F-Series CIRJE-F-948, CIRJE, Faculty of Economics, University of Tokyo.
    18. 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.
    19. Di Matteo, Livio, 2005. "The macro determinants of health expenditure in the United States and Canada: assessing the impact of income, age distribution and time," Health Policy, Elsevier, vol. 71(1), pages 23-42, January.
    20. Di Matteo, Livio, 2014. "Physician numbers as a driver of provincial government health spending in Canadian health policy," Health Policy, Elsevier, vol. 115(1), pages 18-35.

    More about this item

    Keywords

    Managed care; Health care expenditure; Pharmaceutical expenditur; Panel data; German health care reform;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health
    • L14 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Transactional Relationships; Contracts and Reputation
    • O52 - Economic Development, Innovation, Technological Change, and Growth - - Economywide Country Studies - - - Europe

    NEP fields

    This paper has been announced in the following NEP Reports:

    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:lue:wpaper:284. 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: Joachim Wagner (email available below). General contact details of provider: https://leuphana.de/institute/ivwl.html .

    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.