Modelle für die Zukunft der gesetzlichen Krankenversicherung
Ingmar Kumpmann
Kostenträger Entscheiderbrief 4/2009,
2009
Abstract
A discussion of different health insurance models and implications for the German health care system.
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Monopolistic Competition and Costs in the Health Care Sector
Ingmar Kumpmann
IWH Discussion Papers,
No. 17,
2009
Abstract
Competition among health insurers is widely considered to be a means of enhancing efficiency and containing costs in the health care system. In this paper, it is argued that this could be unsuccessful since health care providers hold a strong position on the market for health care services. Physicians exert a type of monopolistic power which can be described by Chamberlin’s model of monopolistic competition. If many health insurers compete with one another, they cannot counterbalance the strong bargaining position of the physicians. Thus, health care expenditure is higher, financing either extra profits for physicians or a higher number of them. In addition, health insurers do not have an incentive to contract selectively with health care providers as long as there are no price differences between physicians. A monopolistic health insurer is able to counterbalance the strong position of physicians and to achieve lower costs.
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Securitization and the Declining Impact of Bank Finance on Loan Supply: Evidence from Mortgage Originations
Elena Loutskina, Philip E. Strahan
Journal of Finance,
No. 2,
2009
Abstract
Low‐cost deposits and increased balance sheet liquidity raise banks' supply of illiquid loans more than loans easily sold or securitized. We exploit the inability of Fannie Mae and Freddie Mac to purchase jumbo mortgages to identify an exogenous change in liquidity. The volume of jumbo mortgage originations relative to nonjumbo originations increases with bank holdings of liquid assets and decreases with bank deposit costs. This result suggests that the increasing depth of the mortgage secondary market fostered by securitization has reduced the effect of lender's financial condition on credit supply.
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In Search of the Best Solution – Four Models of Health Insurance
Ingmar Kumpmann
Wirtschaft im Wandel,
No. 11,
2008
Abstract
In this article, a classification of health insurance systems is proposed. Four ideal type models can be distinguished. The advantages and disadvantages of these models are discussed and empirically investigated. Health insurance systems with a high degree of monopoly and high participation of the state result in lower health care expenditures than systems with various competing health insurance funds. In systems with independent health insurance funds, patients do have more rights than in systems with directly state-driven health care services.
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Grenzen des Wettbewerbs im Gesundheitswesen
Ingmar Kumpmann
Sozialer Fortschritt,
2008
Abstract
Many health economists demand more competition in the health-care system. They focus on the competition between the individual health-insurance funds for those who want such insurance as well as on the competition between health-care providers for contracts with the health-insurance funds. However, they neglect the competition between health-care providers for patients; such competition is crucial for medical quality. This latter area of competition is in conflict with the two former ones. The empirical evidence on the effects of competition on cost and quality are also ambiguous. Thus, the mere appeal for „more competition“ does not do justice to the highly complex nature of the health-care system.
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Grenzen des Wettbewerbs im Gesundheitswesen
Ingmar Kumpmann
IWH Discussion Papers,
No. 1,
2008
Abstract
Many health economists demand more competition in the health care system. They focus on the competition between sickness funds for insured and the competition between health care providers for contracts with sickness funds. But they neglect the competition between health care providers for patients which is crucial for medical quality. This third field of competition is in conflict with the two former fields. The empirical evidence concerning the effects of competition on cost and quality is also ambiguous. Thus the mere claim for “more competition” does not do justice to the high complexity of the health care system.
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For a Sustainable Contribution Rate of the Statutory Unemployment Insurance
Ingmar Kumpmann
Wirtschaft im Wandel,
No. 11,
2007
Abstract
The German Federal Government has decided to decrease the contribution rate of the statutory unemployment insurance from 4.2 to 3.3 per cent of gross wages. The unemployment insurance retards the income loss in times of increasing unemployment, which has a dampening effect on the business cycle. In order not to countervail this effect it is necessary to hold the contribution rate stable over times with high and low unemployment. Therefore, the budget surplus of the unemployment insurance agency in the current economic upswing is no sufficient argument for a contribution cut. A present reduction of the contribution rate induces the risk of a new contribution rise in the next economic slowdown. It would be better to build up sufficient reserves so that a contribution rise will be avoidable even in times with increasing unemployment.
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Neue Unternehmen sind Hoffnungsträger
Jürgen Schmude, Kerstin Wagner
External Publications,
2006
Abstract
The paper reveals firm birth rates and survivor rates at the level of German districts (Kreise). Rates vary both between regions and industries. For the business service and bank/insurance sector, firm formation rates are above-median of the private economy, while production industries show highest survivor rates.
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The coalition treaty from a fiscal point of view
Kristina vanDeuverden
Wirtschaft im Wandel,
No. 12,
2005
Abstract
After weeks of negotiations the coalition finally agreed on the conditions for their political work. Not surprisingly, the coalition agreement is complex and intransparent – with a multitude of single measures far away from a precise definition. Quantifying the programme and estimating resulting cash flows is currently difficult; official calculations are – if at all – only partly available. Anyhow, the contract will form the basis for economic policy during the next four years; therefore its evaluation by now is indispensable. The thin red line of the agreement – not astonishingly when considering the precarious financial situation of the public sector – is consolidation. However, more than 80% of the consolidation volume results from the revenue side. Though one third of this is due to the cutback of tax exemptions, the lion’s share comes from raising tax rates, mainly the VAT standard rate. In contrast, cutting back public expenditure is minor and the agreement clearly comes short of the Koch/Steinbrück proposal; even new tax reliefs are created. The consolidation is almost completely borne by private households. Enterprises as a whole are barely hit. However, they have to wait until 2008 for a reform of company taxation – one of the most pressing problems in this legislative period. To reduce the companies tax burden until the reform starts the conditions for tax depreciation are temporarily relaxed. Anyway, from an international point of view the statutory tax rate is an important signal to enterprises deciding where to invest. Lowering effective tax rates by changing depreciation conditions is intransparent and, thus, will be less effective. Furthermore savings within the public sector are planned to accomplish consolidation; 10 billion Euro should result from efficiency gains and reduced expenditure. Consolidation measures mainly focus on the budget of the federal government. However, Länder and communities will participate in the additional tax revenues. In contrast, social securities will loose – and therefore also the share of employment that is subject to social insurance contribution. Particularly the unemployment insurance will be burdened by the decrease of its premium rate. Besides, the federal government will reduce its grants to the pension funds and most notably the health system. The contract is dominated by fiscal constraints. Cyclical requirements are considered only cursory and pressing structural reforms are put off. The reforms of company’s taxation, of fiscal federalism, of the health system as well as a proceeding reform of the labour market are only proposed. How and when measures in these fields are realised will determine whether fiscal policy can set a new course.
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