Does managed care reduce health care expenditure? Evidence from spatial panel data
Tóm tắt
Similar to, for example, the US, Switzerland or Great Britain the German health care sector has recently undergone a series of reforms towards managed care. These measures are intended to yield both a higher quality of care and cost containment. In our study we ask whether managed care reduces health care expenditure at the market level. We apply a macroeconomic evaluation approach based on a regional panel data set which is as yet unique in the context of managed care. Econometrically, we account for both unobserved heterogeneity and spatial dependence, i.e. regional interrelations in health care. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending, in particular through regional spillover effects.
Tài liệu tham khảo
Alexander, D., Flynn, J., & Linkins, L. (1994). Estimates of the demand for ethical pharmaceutical drugs across countries and time. Applied Economics, 26, 821–826.
Atella, V. (2000). Drug cost containment policies in Italy: Are they really effective in the long-run? The case of minimum reference price. Health Policy, 50(3), 197–218.
Baltagi, B., & Li, Q. (1991). A joint test for serial correlation and random individual effects. Statistics & Probability Letters, 11(3), 277–280.
Bech, M., & Lauridsen, J. (2009). Exploring spatial patterns in general practice expenditure. European Journal of Health Economics, 10(3), 243–254.
Belotti, F., Hughes, G., & Mortari, A.P. (2013). xsmle: Stata module for spatial panel data models estimation.
Braun, S., & Greiner, W. (2010). Gesundheitsökonomische Evaluation der Integrierten Versorgung ’OPTI-MuM’. Das Gesundheitswesen, 72, 71–77.
Chernew, M., Hirth, R., Sonnad, S., Ermann, R., & Fendrick, A. (1998). Managed care, medical technology, and health care cost growth: A review of the evidence. Medical Care Research and Review, 55(3), 259–288.
Costa-Font, J., & Pons-Novell, J. (2007). Public health expenditure and spatial interactions in a decentralized national health system. Health Economics, 16, 291–306.
Crivelli, L., Filippini, M., & Mosca, I. (2006). Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons. Health Economics, 15(5), 535–41.
Domino, M., & Salkever, D. (2003). Price elasticity and pharmaceutical selection: The influence of managed care. Health Economics, 12(7), 565–586.
Elhorst, J. P. (2014). Spatial econometrics. Heidelberg: Springer. (From Cross-Sectional Data to Spatial Panels).
Elhorst, J. P. (2010). Applied spatial econometrics: Raising the bar. Spat Economic Analysis, 5(1), 9–28.
Felder, S., & Tauchmann, H. (2013). Federal state differentials in the efficiency of health production in Germany: An artifact of spatial dependence? European Journal of Health Economics, 14(1), 21–39.
Florax, R., Folmer, H., & Rey, S. J. (2003). Specification searches in spatial econometrics: The relevance of Hendry’s methodology. Regional Science and Urban Economics, 33(5), 557–579.
Gerdtham, U., & Jönsson, B. (2000). International comparisons of health expenditure: Theory, data and econometric analysis. In A. Culyer & J. Newhouse (Eds.), Handbook of health economics (Vol. 1). Amsterdam: Elsevier.
Gerdtham, U., Søgaard, J., Andersson, F., & Jönsson, B. (1992). An econometric analysis of health care expenditure: A cross-section study of the OECD countries. Journal of Health Economics, 11(1), 63–84.
Grossman, M. (1972). On the concept of health capital and the demand for health. Journal of Political Economy, 80(2), 223–255.
Grothaus, F. (2009). Entwicklung der integrierten Versorgung in der Bundesrepublik Deutschland 2004–2008. Bundesgeschäftsstelle Qualitätssicherung gGmbH.
Harris, B., Stergachis, A., & Ried, L. (1990). The effect of drug copayments on utilization and cost of pharmaceuticals in a health maintenance organization. Medical Care, 28(10), 907–917.
Hitiris, T., & Posnett, J. (1992). The determinants and effects of health expenditure in developed countries. Journal of Health Economics, 11, 173–181.
Hyndman, R. J., Athanasopoulos, G., Razbash, S., Schmidt, D., Zhou, Z., & Khan, Y. (2013). forecast: Forecasting functions for time series and linear models. R Package Version 4.03.
Konetzka, R., Zhu, J., Sochalski, J., & Volpp, K. (2008). Managed care and hospital cost containment. Inquiry, 45(1), 98–111.
LeSage, J. P. (2009). An introduction to spatial econometrics. Boca Raton: CRC Press.
López-Casasnovas, G., & Saez, M. (2007). A multilevel analysis on the determinants of regional health care expenditure: A note. European Journal of Health Economics, 8(1), 59–65.
Lyles, A., & Palumbo, F. (1999). The effect of managed care on prescription drug costs and benefits. PharmacoEconomics, 15(2), 129–40.
Millo, G., & Piras, G. (2012). splm: Spatial panel data models in R. J. Stat. Softw., 47(1).
Moscone, F., Knapp, M., & Tosetti, E. (2007). Mental health expenditure in England : A spatial panel approach. Journal of Health Economics, 26(4), 842–864.
Mur, J., & Angulo, A. (2009). Model selection strategies in a spatial setting: Some additional results. Regional Science and Urban Economics, 39, 200–213.
Murray, M., & Deardorff, F. (1998). Does managed care fuel pharmaceutical industry growth? PharmacoEconomics, 14(4), 341–348.
Okunade, A., & Suraratdecha, C. (2006). The pervasiveness of pharmaceutical expenditure inertia in the OECD countries. Social Science & Medicine, 63, 225–238.
Parkin, D., McGuire, A., & Yule, B. (1987). Aggregate health care expenditures and national income: Is health care a luxury good? Journal of Health Economics, 6, 109–127.
Prieto, D., & Lago-Peñas, S. (2012). Decomposing the determinants of health care expenditure: The case of Spain. European Journal of Health Economics, 13(1), 19–27.
Reich, O., Rapold, R., & Flatscher-Thöni, M. (2012a). An empirical investigation of the efficiency effects of integrated care models in Switzerland. International Journal of Integrated Care, 12, e2.
Reich, O., Weins, C., Schusterschitz, C., & Thöni, M. (2012b). Exploring the disparities of regional health care expenditures in Switzerland: Some empirical evidence. European Journal of Health Economics, 13(2), 193–202.
Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. (2009). Koordination und Integration - Gesundheitsversorgung in einer Gesellschaft des längeren Lebens. Baden-Baden: Nomos.
Sachverständigenrat zur Begutachtung der Entwicklung im Gesundheitswesen. (2012). Wettbewerb an der Schnittstelle zwischen ambulanter und stationärer Gesundheitsversorgung. Bern: Huber.
Schmitz, H. (2011). Why are the unemployed in worse health? The causal effect of unemployment on health. Labour Economics, 18(1), 71–78.
Stafford, R., Davidson, S., Davidson, H., Miracle-McMahill, H., Crawford, S., & Blumenthal, D. (2003). Chronic disease medication use in managed care and indemnity insurance plans. Health Services Research, 38(2), 595–612.
Tobler, W. R. (1970). A computer movie simulating urban growth in the Detroit region. Economic Geography, 46, 234–240.
Wagstaff, A. (1986). The demand for health: Some new empirical evidence. Journal of Health Economics, 5, 195–233.
Wallack, S., Thomas, C., Martin, T., & Ryan, A. (2007). Differences in prescription drug use in HMO and self-insured health plans. Medical Care Research and Review, 64(1), 98–116.
Weiner, J., Lyles, A., Steinwachs, D., & Hall, K. (1991). Impact of managed care on prescription drug use. Health Affairs, 10(1), 140–154.
Wooldridge, J. (2010). Econometric analysis of cross section and panel data (2nd ed.). Cambridge: The MIT Press.
Zweifel, P., Breyer, F., & Kifman, M. (2009). Health economics (2nd ed.). New York: Springer.