Folgen des Wettbewerbs zwischen Krankenversicherungen für die Kosten im Gesundheitswesen
Ingmar Kumpmann
Gesundheitspolitik, Wettbewerb und Gesundheitssystemforschung. DIBOGS-Beiträge zur Gesundheitsökonomie und Sozialpolitik Bd. 3,
2009
Abstract
In this study it is argued that competition among health insurers can bring about higher costs in the health care sector. Medical services are inhomogeneous goods; thus the competition between physicians can be modeled by Chamberlins concept of monopolistic competition. The physicians have a strong bargaining power face to face a multitude of competing health insurers acting as purchasers of health care services. The costs can be lower if the physicians’ strong position is compensated by a monopolistic health insurer. Two case studies show the applicability of the argument. A regression analysis confirms the correlation between (public) monopolistic health insurer and lower costs in the health care sector.
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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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Municipal Enterprises as Shadow Budgets – How do they Affect the Actual Budgetary Situation of Germany´s Local Governments?
Peter Haug
Wirtschaft im Wandel,
No. 5,
2009
Abstract
Outsourcing of municipal tasks from the core budget to municipal enterprises tends to distort the perception of the actual financial position, net assets and results of operations of the German local governments. Excess supply or -demand of/for local public services might be possible consequences of this development. Hence, this article attempts to develop a more comprehensive picture of the municipal budgetary position by a simultaneous analysis of selected indicators. Furthermore, the methodological problems of the calculations are illustrated.
If these shadow budgets are taken into account, the total per capita revenues, -investments and -debts will increase by approximately one third to 50%. However, the share of the municipal employees belonging to the core administration in the total number of municipal employees is 75%. Although only about 22% of the expenditures for certain voluntary municipal tasks have been outsourced, there seems to be an upward trend.
The study also indicates that there are significant differences between Eastern and Western German cities. These include the higher revenues from municipal enterprises, the higher debts per capita and the higher expenditures on culture, sports, leisure services or the promotion of science in Eastern Germany.
The results should be interpreted carefully due to some shortcomings of the official statistics. For example, internal cash flows cannot be totally eliminated. Moreover, indirect municipal majority holdings as well as the municipal savings banks are not included in the results.
All in all, it remains to be seen whether the initiated reforms concerning the introduction of double-entry accounting into the local government budgeting system will help to achieve the ideal goal of a meaningful “consolidated financial statement” for the “city company”.
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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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Spatial Distribution of East German Innovative Competencies: Significant Increase in the Southwestern Hinterland of Berlin and in the Centres of Saxony and Thuringia
Peter Franz
Wirtschaft im Wandel,
No. 9,
2007
Abstract
Patent applications constitute an essential indicator for the extent of innovative activities in an economy or region. Due to the fact that innovative activities are in general spatially concentrated, policy makers perceive in this information starting points for a growth-oriented regional policy. Against this background, the Halle Institute for Economic Research (IWH) in 2004 had examined the spatial distribution of industries, firm networks and innovative competencies in the context of an area-wide study for East Germany. Newly available data for the patent statistics allow for an updating of these results regarding the innovative competencies for the time period from 2000 to 2005. In comparison to the time period between 1995 and 2000, an increase in innovative competencies becomes evident. This growth takes place almost exclusively in regions where innovative competencies are already domiciled. All in all, the growth dynamics of East Germany with regard to patent applications is slightly behind the West German one. The distribution of technological fields, to which the applied patents refer to, remained largely constant during the two observation periods. In the area of bio-technology, electrical engineering and of health care the standing of East Germany has further improved. With regard to political implications, the data should not be used for imposing technology specific support programs. Instead a tax relief for R&D independent of the used technologies seems to be more adequate.
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Health reform: Increase of gains instead of structural reforms
Ingmar Kumpmann
Wirtschaft im Wandel,
No. 8,
2006
Abstract
Die Regierungskoalition hat die Eckpunkte für eine neue Gesundheitsreform vorgelegt. Die wichtigsten Maßnahmen sind die Erhöhung der Krankenkassenbeiträge um ca. 0,5 Prozentpunkte, die Erhöhung der Steuerzuschüsse für die Krankenkassen, die Verteilung der Beiträge und Steuerzuschüsse auf die Krankenkassen durch einen Gesundheitsfonds und die Schaffung der Möglichkeit für die Krankenkassen, daneben noch Zusatzbeiträge zu erheben. Es dominieren somit Maßnahmen zur Erhöhung der Einnahmen. Die enge Bindung der Beiträge an die Beschäftigung von Arbeitskräften wird nicht überwunden. Zugleich wird durch die Zusatzbeiträge ein erster Schritt zur Einführung der Kopfpauschale getan. Denn die Erhebungsform der Zusatzbeiträge ist den Krankenkassen zwar freigestellt, im Wettbewerb dürfte sich aber die Kopfpauschale gegenüber einkommensabhängigen Beiträgen durchsetzen. Sollte die Bedeutung dieser Zusatzbeiträge und damit der Kopfpauschale langfristig zunehmen, hätte dies für das System weitreichende Konsequenzen. Eine Einbeziehung der Zusatzbeiträge in den Risikostrukturausgleich der Krankenkassen und steuerfinanzierte Ausgleichszahlungen für Geringverdiener müßten dann konsequenterweise zusätzlich in Betracht gezogen werden. Es fehlen weitgehend Schritte zur Steigerung der Effizienz des Gesundheitssystems, etwa durch Qualitätsverbesserung oder Kostendämpfung. Somit bleibt die Reform insgesamt unzureichend, um strukturelle Probleme des deutschen Gesundheitssystems zu lösen.
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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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