Regionalmerkmale Im Risikostrukturausgleich (Regional Variation and Germany's Risk Adjustment Scheme)

Currently, there are discussions about introducing a regional variable into the risk adjustment scheme of Germany's statutory health insurance (SHI). To evaluate such suggestions a better understanding of regional variations in health care expenditure is needed. This article shows the extent of regional variation in SHI health expenditure at the Landkreis (county) level, analyses the extent to which these are already compensated by the current risk adjustment scheme and examines possible causes of the remaining variation.Per capita SHI health expenditure is shown to vary by a factor of 1.6 between German counties. Age and gender can explain about 30% of this variation. Health status explains another 14 %. Overall, the current risk adjustment scheme compensates for 44% of regional variation in health expenditure. Still, relevant variation remains. Indicators of social status (education, income, unemployment) do not add further explanatory power. Factors for the remaining differences are: medical supply, urbanization, single-person households.As differences in medical supply that do not reflect differences in need should not be included in a risk adjustment scheme, mechanisms for separating demand side and supply side factors are needed