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Many healthcare systems prohibit primary care physicians from dispensing the drugs they prescribe due to concerns that this encourages excessive, ineffective or unnecessarily costly prescribing. Using data from the English National Health Service for 2011 to 2018, we estimate the impact of physician dispensing rights on prescribing behaviour at the extensive margin (comparing practices that dispense and those that do not) and the intensive margin (comparing practices with different proportions of patients to whom they dispense). Our empirical strategy controls for practices selecting into dispensing based on observable (OLS, entropy balancing) and unobservable practice characteristics (2SLS). We show that physician dispensing raises drug costs per patient by 4.2%, which reflects more and more expensive drugs being prescribed, including potentially inappropriate substances such as opioids. Dispensing practices also prescribe smaller packages as reimbursement is partly based on a fixed fee per prescription dispensed. Similar effects are observed at the intensive margin.

Increasing long-term care demand raises the need of high quality care in nursing homes. This study analyses whether higher prices have a causal effect on quality of care in Swiss nursing homes and assesses the extent of cross-subsidization between different price components. We use administrative data collected by the Swiss Federal Office for Statistics from 2012 to 2016 on all nursing homes in the twelve Swiss cantons with canton-wide fixed reimbursement rates for nursing care. We apply multivariate linear regressions and two-stage least square estimation techniques to estimate the effect of nursing care prices and prices for accommodation and services on care quality, measured by registered staffing levels. Our estimates show a positive impact of all price components on care quality. Although nursing homes are prohibited to use revenues from accommodation and services to cover nursing care, a 10% increase in that price component increases certified staffing levels by 0.7 to 1.7 nurses or four to ten percent (full-time-equivalent) for an average sized nursing home (50 beds). Thus, limiting care prices implicitly sets a limit for care quality and induces care providers to pass on costs to the residents. Die steigende Nachfrage nach Langzeitpflege erhöht den Bedarf an qualitativ hochwertiger Pflege in Pflegeheimen. In dieser Studie wird untersucht, ob höhere Preise einen Einfluss auf die Versorgungsqualität in Schweizer Pflegeheimen haben, und das Ausmaß der Quersubventionierung zwischen verschiedenen Preiskomponenten bewertet. Wir verwenden administrative Daten aller Pflegeheime der zwölf Schweizer Kantone mit kantonalen Festbeträgen für die Altenpflege, die das Bundesamt für Statistik für die Jahre 2012 bis 2016 erhoben hat. Wir wenden multivariate lineare Regressionen und 2SLS an, um die Auswirkungen von Pflegepreisen und Preisen für Unterkunft und Dienstleistungen auf die Pflegequalität, gemessen am Personalbestand an Pflegefachkräften, zu schätzen. Unsere Ergebnisse zeigen einen positiven Einfluss aller Preiskomponenten auf die Pflegequalität. Zwar ist es Pflegeheimen nicht gestattet Einnahmen aus Unterkünften und Dienstleistungen für die Pflege zu verwenden, doch erhöht eine um 10% erhöhte Preiskomponente die Zahl der Pflegefachkräfte um 0,7 bis 1,7 Pflegefachkräfte (Vollzeitäquivalent) bzw. um vier bis zehn Prozent bezogen auf ein durchschnittlich großes Pflegeheim (50 Betten). Die Begrenzung der Pflegepreise setzt somit implizit eine Grenze für die Pflegequalität und bewirkt, dass die Leistungserbringer die Kosten für Pflege an die Bewohner weitergeben.

Giving registered organ donors priority on organ waiting list can substantially increase the number of donors and save lifes. Evidence for these effects comes from recent experiments that implemented such priority rules in abstract laboratory environments. In these experiments, participants who registered as organ donors were fully prioritized over those who did not. In the field, however, registering as a donor is only one factor affecting the recipient’s score. In this paper, we provide a comparative statics analysis of the priority treatment by varying the number of bonus periods that a registered person can skip on the waiting list. We find that behavior is monotonic: giving more priority to registered donors leads to higher registration rates. Our results also indicate that a medium sized bonus improves registration rates as much as absolute priority (used in the previous literature).

Relocation of production to countries with low labour cost have induced increased labour market flexibility, which has been praised as a silver bullet for economic growth and low unemployment. Within a unionised oligopoly framework, in which a multi-national firm has the option to relocate its production to a foreign country, we analyse the welfare implications of both centralised and flexible wage setting regimes. For very low foreign wages, wage flexibility leads to higher welfare than a rigid centralised regime. In contrast, for 'intermediate' wage levels in the foreign country, an industry-wide uniform wage leads to higher social welfare than flexible wages.

Health insurances curb price insensitive behavior and moral hazard of insureds through different types of cost-sharing, such as tiered co-payments or reference pricing. This paper evaluates the effect of newly introduced price limits below which drugs are exempt from co-payments on the pricing strategies of drug manufacturers in reference price markets. We exploit quarterly data on all prescription drugs under reference pricing available in Germany from 2007 to 2010. To identify causal effects, we use instruments that proxy regulation intensity. A difference-in-differences approach exploits the fact that the exemption policy was introduced successively during this period. Our main results first show that the new policy led generic firms to decrease prices by 5 percent on average, while brand-name firms increase prices by 7 percent after the introduction. Second, sales increased for exempt products. Third, we find evidence that differentiated health insurance coverage (public versus private) explains the identifed market segmentation.

Recent laboratory experiments have demonstrated that prioritizing registered donors on the waiting list impressively increases the willingness to register as an organ donor. In these experiments, registered organ recipients are prioritized regardless of howlong they have been on thewaiting list. In the field, however, the willingness to register is only one factor affecting the waiting list. In this paper, we provide a comparative-statics analysis of the priority treatment by varying the number of bonus periods a registered person can skip on thewaiting list. We want to assess how much of a priority bonus registered persons should obtain in order for registration rates to improve. Our results indicate that a higher number of bonus periods significantly improves registration rates whereas a small bonus of only one period is of minor significance. A bonus of three periods ofwaiting time has the same effect as absolutely prioritizing registered recipients.

"This contribution gives an overview of the main results of our theoretical research on the stability and change of labour market institutions. We use so-called models of unionised oligopolies which are borrowed from the theory of industrial organization in order to analyse the effects of simultaneous market power in both labour and product markets. The focus of our research is on the interaction between various organisational structures of labour markets and different forms of product market competition. In particular, we analyse some recent developments in Germany, such as the introduction of sector-specific minimum wages, the formation of craft unions, the increasing number of profit sharing contracts as well as the relocation of production facilities to foreign countries." (Author's abstract, IAB-Doku) ((en))

Since 2009, German nursing homes have been evaluated regularly with quality report cards published online. We argue that most of the information in the report cards does not reliably measure quality of care, but a subset of seven measures does. Using a sample of more than 3,000 nursing homes with information on two waves, we find a significant improvement in the nursing home quality from the first to the second evaluation. Both indicators comprising either the two outcome quality measures or the seven measures indicating "risk factors" in the report cards improve. This can be interpreted as evidence that quality disclosure positively affects the (reported) quality in nursing homes.

This paper evaluates the impact of reference pricing on prices and co-payments in the (German) market for off-patent pharmaceuticals. We present a theoretical model with price-sensitive and loyal consumers that shows that a decrease in the reference price affects the consumers' co-payments in a non-monotonic way: For high reference prices, a marginally lower reference price may lead to lower co-payments. However, for low reference prices a further reduction may result into higher consumer co-payments. We use quarterly data on reference priced drugs covered by the social health insurance in Germany over the period 2007 - 2010 to analyze the empirical effects of reference price reductions. We find that, while prices decrease due to the reduction, co-payments behave non-monotonically and indeed increase if the reference price is sufficiently low.

Sechs Seminar-/Projektarbeiten von Studierenden des Moduls Gesundheitsökonomie (Bsc. VWL und Bsc. BWL) der Wirtschaftswissenschaftlichen Fakultät der Heinrich-Heine-Universität Düsseldorf aus dem Sommer 2012. Inhaltsverzeichnis, Band 1: Krankenhäuser. Kapitel 1: Steffen Grisse: Marktabgrenzung und Wettbewerb im deutschen Krankenhausmarkt - Überlegungen zur Fusion der Fresenius HELIOS-Kliniken Gruppe mit der Rhön-Klinikum AG, S.1. Kapitel 2: Mona Groß: Qualität von Krankenhäusern: Welche Maße werden in Deutschland diskutiert und was sagt die Praxis in den USA, S.21

Sechs Seminar-/Projektarbeiten von Studierenden des Moduls Gesundheitsökonomie (Bsc. VWL und Bsc. BWL) der Wirtschaftswissenschaftlichen Fakultät der Heinrich-Heine-Universität Düsseldorf aus dem Sommer 2012. Inhaltsverzeichnis, Band 2: Arzneimittel. Kapitel 3: Dmitrij Schneider: Vertrauens- und Erfahrungsgüter auf dem Arzneimittelmarkt: Theoretische Modellierungsansätze und Preisdifferenzierung, S.46. Kapitel 4: Svenja Bauch: Das Generic Competition Paradox, S.61. Kapitel 5: Paul Haag: Entscheidungsunterstützung durch gesundheitsökonomische Evaluationen in Deutschland, S.76. Kapitel 6: Vanessa Kuske: Konsumentenwerbung bei Produktdifferenzierung, Preisregulierung und asymmetrischer Information: Wann sollte sie verboten bzw. erlaubt werden?, S.91

Sechs Seminar-/Projektarbeiten von Studierenden des Moduls Gesundheitsökonomie (Bsc. VWL und Bsc. BWL) der Wirtschaftswissenschaftlichen Fakultät der Heinrich-Heine-Universität Düsseldorf aus dem Sommer 2012. Inhaltsverzeichnis, Band 2: Arzneimittel. Kapitel 3: Dmitrij Schneider: Vertrauens- und Erfahrungsgüter auf dem Arzneimittelmarkt: Theoretische Modellierungsansätze und Preisdifferenzierung, S.46. Kapitel 4: Svenja Bauch: Das Generic Competition Paradox, S.61. Kapitel 5: Paul Haag: Entscheidungsunterstützung durch gesundheitsökonomische Evaluationen in Deutschland, S.76. Kapitel 6: Vanessa Kuske: Konsumentenwerbung bei Produktdifferenzierung, Preisregulierung und asymmetrischer Information: Wann sollte sie verboten bzw. erlaubt werden?, S.91

Many countries with national health care providers and health insurances regulate the market for pharmaceuticals to steer drug demand and to control expenses. For example, they introduce reference pricing or tiered co-payments to enhance drug substitution and competition. Since 2006, Germany follows an innovative approach by differentiating drug co-payments by the drug's price relative to its reference price. In this two-tier system, prescription drugs are completely exempted from co-payments if their prices undercut a certain price level relative to the reference price. We identify the effect of the policy on the prices of all affected prescription drugs and differentiate the analysis by firm types (innovative, generic, branded generic or importing firms). To identify a causal effect, we use a differences-in-differences approach and additionally exploit the fact that the exemption policy had been introduced successively in the different clusters. We use quarterly data from 2007 to 2010 and find empirical evidence for differentiated price setting strategies by firm types, ranging from price decreases of -13.1% (branded generics firms) to increases of +2.0% (innovators) following the introduction of potential reductions in co-payments. We refer to the latter result as the co-payment exemption paradox. Our competition proxy (no. of firms) suggests a significant but small negative correlation with prices.

Rationalisierungsmaßnahmen sind bei steigenden Ausgaben in einem vor allem durch Umlagen finanzierten Gesundheitssystem wichtige Mittel zur Erreichung einer effizienten Produktion und Allokation der Ressourcen. In diesem Artikel werden verschiedene deutsche Regulierungsansätze zur Stärkung des Wettbewerbs und der Effizienz im Arzneimittelmarkt beschrieben und ökonomisch bewertet. Zwei Schwerpunkte der Analyse liegen auf dem Preiswettbewerb im Festbetragsmarkt durch Zuzahlungsbefreiungsgrenzen (sukzessive seit 2006) sowie auf der neuen Erstattungsregulierung des Arzneimittel-Neuordnungsgesetzes (AMNOG, seit 2011) für neue, patentierte Arzneimittel.

In den letzten Jahren haben die durch das Bundeskartellamt behandelten Fusionskontrollverfahren im Krankenhaussektor zu einer anhaltenden wettbewerbsökonomischen Debatte geführt. Als eine wichtige Erkenntnis hat sich hierbei ergeben, dass für den überwiegenden Bereich der akutstationären Krankenhausversorgung von einer vergleichsweise engen räumlichen Marktabgrenzung auszugehen ist, der Wettbewerb zwischen Krankenhäusern daher in der Region ausgetragen wird. Das vorliegende Papier untersucht Regionalität und Krankenhauswettbewerb unter verschiedenen Aspekten: Insbesondere beleuchten wir die marktverschließenden Wirkungen der dualistischen Krankenhausfinanzierung, gehen auf die besondere Problematik von Krankenhäusern in der Fusionskontrolle ein und arbeiten das Ob und Wie wesentlicher Konsequenzen von Regionalität in der Versorgung mit Krankenhausleistungen heraus. Zudem greifen wir den Vorschlag der Monopolkommission auf, die Fusionskontrolle im Krankenhausbereich zu verschärfen, um der Regionalität der Krankenhausmärkte gerecht zu werden. The increasing number of hospital mergers over the last few years has lead to some debate over the form and degree of competition between hospitals. An important conclusion has been that the geographic definition of the relevant market should be rather narrow when considering inpatient care units. Thus, competition between hospitals takes place in the region. This paper analyses regionalism and hospital competition, highlighting several aspects: We shed light on the market-foreclosing effects of the dual financing system, discuss the special features of hospitals within the German merger control regime and underline the consequences of regionalism for the provision of hospital care. In addition, we follow the proposal made by the German Monopolies Commission to strengthen the merger control regime in order to subject more regional mergers to merger control.

It is a persistent phenomenon in many societies that a large proportion of alcohol consumption takes place in company of other people. While the phenomenon of social or public drinking is well discussed in disciplines as social psychology and anthropology, economists have paid little attention to the social environment of alcohol consumption. This paper tries to close this gap and explains social drinking as a trust facilitating device. Since alcohol consumption tends to make some people (unwillingly) tell the truth, social drinking can eventually serve as a signaling device in social contact games. Empirical support is obtained from a cross-country analysis of trust and a newly developed index of moderate alcohol consumption.

Der vorliegende Beitrag analysiert den Ordnungsrahmen für den deutschen Apothekenmarkt und die dortigen Konkurrenzbeziehungen, welche durch signifikante Wettbewerbsdefizite gekennzeichnet sind. Ausgehend von unserer Diagnose und den Befunden werden die Vor- und Nachteile von zwei Therapieoptionen als diskutiert: Das sogenannte Selektivertragsmodell, bei dem Apotheken um das Kollektiv der Versichertengemeinschaft einer jeden Krankenkasse konkurrieren, und das Modell der Apothekentaxe, bei dem die Patienten die Leistung der Apotheke direkt vergüten. Für das Modell der Apothekentaxe werden in drei Szenarien die Wettbewerbswirkungen und das mögliche Einsparpotenzial pro Jahr ermittelt, dass sich auf bis zu 448 Mio. EUR beläuft.

This paper investigates the cost and profit efficiency of German hospitals and their variation with ownership type. It is motivated by the empirical finding that private (for-profit) hospitals – having been shown to be less cost efficient in the past – on average earn higher profits than public hospitals. We conduct a Stochastic Frontier Analysis on a multifaceted administrative German data set combined with the balance sheets of 541 hospitals of the years 2002–2006. The results show no significant differences in cost efficiency but higher profit efficiency of private than of publicly owned hospitals. Copyright © 2010 John Wiley & Sons, Ltd.

Hospital markets are often characterised by price regulation and the existence of different ownership types. Using a Hotelling framework, this paper analyses the effect of heterogeneous objectives of the hospitals on quality differentiation, profits, and overall welfare in a price regulated duopoly with exogenous symmetric locations. In contrast to other studies on mixed duopolies, this paper shows that in this framework privatisation of the public hospital may increase overall welfare. This holds if the public hospital is similar to the private hospital or less efficient and competition is low. The main driving force is the single regulated price which induces under-(over-)provision of quality of the more (less) efficient hospital compared to the first-best. However, if the public hospital is sufficiently more efficient and competition is fierce, a mixed duopoly outperforms both a private and a public duopoly due to an equilibrium price below (above) the price of the private (public) duopoly. This medium price discourages overprovision of quality of the less efficient hospital and - together with the non-profit objective - encourages an increase in quality of the more efficient public hospital.

This paper investigates cost and profit efficiency of German hospitals. More specifically, it deals with the question how hospital efficiency varies with ownership, patient structure,and other exogenous factors, which are neither inputs nor outputs of the production process. We conduct a Stochastic Frontier Analysis (SFA) on a multifaceted administrative German dataset combined with the balance sheets of 374 hospitals for the years 2002 to 2005.The results indicate that private (for-profit) and (private) non-profit hospitals are on average less cost efficient but more profit efficient than publicly owned hospitals.