Subjective and objective quality and choice of hospital: Evidence from maternal care services in Germany.

We study patient choice of healthcare provider based on both objective and subjective quality measures in the context of maternal care hospital services in Germany. Objective measures are obtained from publicly reported clinical indicators, while subjective measures are based on satisfaction scores from a large and nationwide patient survey. We merge both quality metrics to detailed hospital discharge records and quantify the additional distance expectant mothers are willing to travel to give birth in maternity clinics with higher reported quality. Our results reveal that patients are on average willing to travel 0.1-2.7 additional kilometers for a one standard deviation increase in quality. Patients respond to both objective and subjective quality measures, suggesting that patient satisfaction scores may constitute important complements to clinical indicators when choosing provider.

Introducing risk adjustment and free health plan choice in employer-based health insurance: Evidence from Germany.

To equalize differences in health plan premiums due to differences in risk pools, the German legislature introduced a simple Risk Adjustment Scheme (RAS) based on age, gender and disability status in 1994. In addition, effective 1996, consumers gained the freedom to choose among hundreds of existing health plans, across employers and state-borders. This paper (a) estimates RAS pass-through rates on premiums, financial reserves, and expenditures and assesses the overall RAS impact on market price dispersion. Moreover, it (b) characterizes health plan switchers and investigates their annual and cumulative switching rates over time. Our main findings are based on representative enrollee panel data linked to administrative RAS and health plan data. We show that sickness funds with bad risk pools and high pre-RAS premiums lowered their total premiums by 42 cents per additional euro allocated by the RAS. Consequently, post-RAS, health plan prices converged but not fully. Because switchers are more likely to be white collar, young and healthy, the new consumer choice resulted in more risk segregation and the amount of money redistributed by the RAS increased over time.

Explaining Differentials in Subsidy Levels Among Hospital Ownership Types in Germany.

German hospitals receive subsidies for investment costs by federal states. Theoretically, these subsidies have to cover the whole investment volume, but in fact, only 50-60% are covered. Balance sheet data show that public hospitals exhibit higher levels of subsidies compared with for-profit hospitals. In this study, I examine the sources of this disparity by decomposing the differential in a so-called facilitation ratio, that is, the ratio of subsidies to tangible fixed assets, revealing to which extent assets are funded by subsidies. The question of interest is whether the differential can be attributed to observable hospital-specific and federal state-specific characteristics or to unobservable factors. Copyright © 2016 John Wiley & Sons, Ltd.

Determinants of received long-term care - Individual responses to regional nursing home provisions.

Existing literature analyzing the choice of received long-term care by frail elderly (65+ years) predominantly focuses on physical and psychological conditions of elderly people as factors that influence the decision for a particular type of care. Until now, however, the regional in-patient long-term care supply has been neglected as influential factor in this decision-making process. In this study, we analyze the determinants of received long-term care in Germany by explicitly taking the regional supply of nursing homes into account. We estimate a multinomial probit model to illustrate this decision-making process. Therefore, within this discrete choice setting we distinguish between all available types of long-term care in Germany, i.e. four different types of formal and informal care provision. We find that the decision for long-term in-patient care is significantly correlated with the regional supply of nursing home beds, while controlling for physical and psychological conditions of the individual.