Die Sozialabgaben in Deutschland haben mit 42 % die einst als unüberschreitbar geltende "Haltelinie" von 40 % bereits deutlich überschritten. Besonders dramatisch entwickeln sich die Zusatzbeiträge der gesetzlichen Krankenversicherung (GKV): von 1,7 % im Jahr 2024 auf aktuell 2,9 % im zweiten...

Background Medicare Advantage (MA) penetration rates have shown an increase in rural areas in the past decade, increasing the bargaining power of MA plans relative to rural hospitals. We study the effect that this increase has had in the revenue of rural hospitals through reductions in the...

Background Adjusting the health insurance reimbursement rate is essential to optimize the allocation of medical resources. This paper investigates the effect of health insurance reimbursement rates on middle-aged and elderly people's choice of hospitals in China. Methods This study is conducted...

Social health protection systems are constantly evolving, offering a wide range of institutional, administrative, and financial arrangements. International standards in social health protection are outcome-based, and grant flexibility in the institutional and administrative arrangements chosen...

A common approach to markets with adverse selection is to regulate competition to minimize inefficiencies, while preserving consumer choice among firms. We study the role of procurement auctions - leading to sole provision by the winning firm - as an alternative market design. Relative to...

We leverage decades of administrative data and quasi-experimental variation in the introduction of universal long-term care (LTC) insurance in Germany in 1995 to examine whether health insurance expansions can stimulate local economies. We find that the LTC insurance rollout led not only to...

In the 2000s, the Government of the People's Republic of China extended basic health insurance to most of the population. In the 2010s, it introduced a catastrophic medical insurance (CMI) program to further improve urban and rural residents' protection against financial shocks due to inpatient...

Public insurance reimbursement policies shape the structure and reach of healthcare markets. In this study, we examine the 1980 federal Medicaid mandate requiring states to reimburse Certified Nurse-Midwives, one of the first reforms targeting non-physician providers. We find the mandate...

In the Philippines, hospital efficiency and quality are rarely measured because of the limited availability of administrative health data. We used 37 million inpatient claims from PhilHealth (2018-2023) to estimate hospital efficiency and quality across the Philippines. We found stark variation...

Medicare fraud poses a substantial challenge to healthcare systems, resulting in significant financial losses and undermining the quality of care provided to legitimate beneficiaries. This study investigates the use of machine learning (ML) to enhance Medicare fraud detection, addressing key...

Die Sozialabgaben in Deutschland haben mit 42 % die einst als unüberschreitbar geltende "Haltelinie" von 40 % bereits deutlich überschritten. Besonders dramatisch entwickeln sich die Zusatzbeiträge der gesetzlichen Krankenversicherung (GKV): von 1,7 % im Jahr 2024 auf aktuell 2,9 % im zweiten...

Germany spent the most on healthcare out of any country in the EU and is only surpassed worldwide by the USA. However, German health expenditure has not exploded despite the coronavirus pandemic. The declining share of German hospital expenditures is striking. A comparison with the Scandinavian...

The German Federal Government has initiated key projects and reforms for the future development of healthcare in Germany. These include political initiatives for deregulation, digitisation, and large-scale structural projects. However, rather than directly contributing to the relief of the...

Until very recently, Britain's National Health Service used to be beyond argument. The reverence for the health service often precluded anything resembling a rational discussion around it: the social taboos were simply too strong. Yet over the past two years or so, this has begun to change. We...

Die vorliegende Studie diskutiert die Prognoseergebnisse für die Kostenentwicklung im Bereich der obligatorischen Kranken- und Pflegeversicherung (OKP). Innerhalb der deskriptiven Diskussion der Datenlage werden für die Kostengruppen wie auch die Kantone die letztjährigen Wachstumsraten mit...

Upcoding in Medicare has been a topic of interest to economists and policy makers for nearly 40 years. While upcoding is generally understood as "billing for services at higher level of complexity than the service actually pro- vided or documented," it has a wide range of definitions within the...

Background Expanding health insurance is a critical step towards universal health coverage due to its positive effect on reducing unmet health care needs and enhancing equitable access to health care. Despite previous studies on the socioeconomic factors associated with unmet health care needs,...

Background We investigate access disparities in pharmaceutical care among German patients with type 2 diabetes, focusing on differences between public and private health insurance schemes. The primary objectives include investigating whether patients with private health insurance experience...

Background The Affordable Care Act (ACA), enacted in 2010, aimed to improve healthcare coverage for American citizens. This study investigates the impact of Medicaid expansion (ME) under the ACA on the racial and ethnic com- position of nursing home admissions in the U.S., focusing on whether ME...

Background Given the rapid population aging in China, achieving universal health coverage (UHC) presents a primary challenge in addressing unmet healthcare needs and associated inequalities among middle-aged and older adults. Several studies have focused on healthcare utilization and its...

Background Type 1 diabetes (T1D) management exerts a considerable financial burden on patients, caregivers, and developing nations at large. In Ghana, a key governments effort to attenuate the financial burden of T1D on patients was to fashion safety-net mechanisms through financial risk...

Objective The integration of the health insurance fund pool may threaten the sustainability of the fund by increasing its expenditures through the exacerbation of the moral hazard of participations. The purpose of this paper is to assess and predict the impact of the single pool reform of...

Background Acute stroke treatment is time-critical. To provide qualified stroke care in areas without 24/7 availability of a stroke neurologist, the concept of teleneurology was established, which is based on remote video communication through telemedicine organized by telestroke networks. Data...

Background The occurrence of health shocks affects households economically in various ways. It most often leads to missed work, thus inducing a decrease in productivity and a loss of income. These effects are even more significant if the extent of absenteeism is high or if its duration is long....

Background The Statutory Health Insurance scheme is one of two main schemes of health care system financing in Europe. This scheme mainly relies on wage-based contributions from employers and employees and is thus prone to business cycle fluctuations. This turned out to be a problem especially...

For more than 25 years, the Social Security Trust Fund has been projected to run out of money in 2033 (give or take a few years), potentially causing benefits to be severely reduced in the absence of corrective legislative action. Today (February 2024), projections are made by the Social...

In this paper, we examine trends in provider fees charged, government expenditure on private out-of-hospital medical services, and out of pocket costs following policy changes intended to reduce government expenditure. We examine the experience of a high-need patient group: people diagnosed with...

Universal health coverage is a widely shared goal across lower-income countries. We conducted a large-scale, 4-year trial that randomized premiums and subsidies for India's first national, public hospital insurance program, RSBY. We find roughly 60% uptake even when consumers were charged...