Boris Augurzky - Academia.edu (original) (raw)
Papers by Boris Augurzky
Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwic... more Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwicklung, medizinisch-technischer Fortschritt und höherer Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Seit 1992 ist ein jährlicher Anstieg der Gesundheitsausgaben von durchschnittlich 3,3% zu verzeichnen. Der durchschnittliche Beitragssatz zur Gesetzlichen Krankenversicherung (GKV) stieg aus diesem Grund in den vergangenen
Deutschland leistet sich ein im internationalen Vergleich hohes Angebot an medizinischer Versorgu... more Deutschland leistet sich ein im internationalen Vergleich hohes Angebot an medizinischer Versorgung. Im Krankenhausbereich weist Deutschland eine um mehr als 50% höhere Bettendichte auf als die OECD-Länder im Durchschnitt. In der OECD ist in den vergangenen 10 Jahren ein massiver Bettenabbau zu beobachten; Deutschland hinkt trotz des hohen Ausgangswerts hinterher. Im niedergelassenen Bereich liegt die Ärztedichte sowohl bei den Fach-
Das Gesundheitswesen ist eine der bedeutendsten Branchen der deutschen Wirtschaft. Die demografis... more Das Gesundheitswesen ist eine der bedeutendsten Branchen der deutschen Wirtschaft. Die demografische Entwicklung, der medizinisch-technische Fortschritt und ein gestiegener Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Es spricht vieles dafür, dass diese Entwicklung sich fortsetzt. Die Gesundheitswirtschaft könnte daher zu einem wichtigen Wachstumsmotor der deutschen Volkswirtschaft werden. Dafür müsste es der
This paper examines the effect of copayments on doctor visits using the German health care reform... more This paper examines the effect of copayments on doctor visits using the German health care reform of 2004 as a natural experiment. In January 2004, copayments of 10 euros for the first doctor visit in each quarter have been introduced for all adults in the statutory health insurance. Individuals covered by private health insurance as well as youths have been
Propensity score matching is a prominent strategy to reduce imbalance in observational studies. H... more Propensity score matching is a prominent strategy to reduce imbalance in observational studies. However, if imbalance is considerable and the control reservoir is small, either one has to match one control to several treated units or, alternatively, discard many treated persons. The first strategy tends to increase standard errors of the estimated treatment effects while the second might produce a
In times of peak demand hospitals may fail to deliver the high standard of treatment quality that... more In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically.We use the variation of patient admissions over time as a proxy for varying
SSRN Electronic Journal, 2000
We analyse the fi nancial performance of small German hospitals based on balance sheet data of ab... more We analyse the fi nancial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of fi nancial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We fi nd that, on average, small hospitals have more fi nancial diffi culties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profi t hospitals tend to perform very well, small public hospitals face considerable fi nancial problems. Apart from ownership, we fi nd that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better fi nancial performance. JEL Classifi cation: I11, I18
SSRN Electronic Journal, 2000
Die Deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; deta... more Die Deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.ddb.de abrufbar.
Health policy (Amsterdam, Netherlands), 2014
Financial soundness will become more and more difficult in the future for all types of hospitals.... more Financial soundness will become more and more difficult in the future for all types of hospitals. This is particularly relevant for gynaecology and obstetrics departments: while some disciplines can expect higher demand due to demographic changes and progress in medicine and medical technology, the inpatient sector for gynaecology and obstetrics is likely to lose patients in line with these trends. In this paper we estimate future demand for gynaecology and obstetrics in Germany and develop a cost model to calculate the average profitability in this discipline. The number of inpatient cases in gynaecology and obstetrics can be expected to decrease by 3.62% between 2007 and 2020 due to the demographic change and a potential shift from inpatient to outpatient services. Small departments within the fields of gynaecology and obstetrics are already incurring heavy losses, and the anticipated decline in cases should increase this financial distress even more. As such, the further centrali...
SSRN Electronic Journal, 2000
Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliograf... more Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.
SSRN Electronic Journal, 2000
Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliograf... more Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.
SSRN Electronic Journal, 2000
Huge underinvestment increases the need for private borrowing in the German hospital sector, the ... more Huge underinvestment increases the need for private borrowing in the German hospital sector, the access to which is partly determined by the probability of default (PD) of individual hospitals. Using ordinary least squares and quantile regression techniques this paper provides first empirical evidence of its kind to evaluate the PD in the hospital sector and its constituent determinants. Based on annual account and medical data from 17% of all German hospitals we find that the current average probability of default amounts to approximately 1.7%, which is slightly higher than the average probability for all German firms. Among other determinants, we find that public ownership significantly increases the risk of default, while private for-profit and private not-for-profit hospitals do not differ. Moreover, demographic change in the form of population growth is confirmed to be relevant for the PD. JEL-Classification: I11, L31.
Der im Oktober 2006 von der Bundesregierung eingebrachte Gesetzesentwurf zur Stärkung des Wettbew... more Der im Oktober 2006 von der Bundesregierung eingebrachte Gesetzesentwurf zur Stärkung des Wettbewerbs in der Gesetzlichen Krankenversicherung (GKV-WSG) sieht die Einführung eines Gesundheitsfonds und die Erhebung von Zusatzprämien bzw. Ausschüttungen an die Versicherten ab 2009 vor. Durch diese Umstellung der Finanzierung der Gesetzlichen Krankenversicherung ist auch mit Verteilungswirkungen zwischen den Bundesländern aus zwei Gründen zu rechnen. Erstens wird durch den
The troubled financing situation of Germany's statutory health insurance (SHI) is a subject ... more The troubled financing situation of Germany's statutory health insurance (SHI) is a subject widely debated in the public. A further reform for 2006 is now in the offing, only three years after the Act on the Modernisation of Statutory Health Insurance came into force. So far, though, little notice has been taken of the need to reform the country's statutory nursing insurance (SNI) - doubtlessly also on account of its smaller volume of contributions compared with SHI. But funding problems similar to those of SHI emerged already back in 1999, the year when expenditure first outstripped revenue. Right now the gap can only be closed with the capital reserve established with the inception of the SNI. But the reserve will be exhausted in only a few years. So it was against this background that a first, albeit modest, reform came in 2005 with the contribution rate being raised by 0.25 percentage points for persons without children. However, no efforts for a lasting solution have ...
Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwic... more Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwicklung, medizinisch-technischer Fortschritt und höherer Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Seit 1992 ist ein jährlicher Anstieg der Gesundheitsausgaben von durchschnittlich 3,3% zu verzeichnen. Der durchschnittliche Beitragssatz zur Gesetzlichen Krankenversicherung (GKV) stieg aus diesem Grund in den vergangenen 10 Jahren von 12,5% auf 15,5% an. Vieles spricht für weiteres Wachstum der Gesundheitsausgaben: Erstens wirkt die Alterung der Bevölkerung Ausgabensteigernd; zweitens führt der medizinisch-technische Fortschritt zu steigender Nachfrage nach Gesundheitsleistungen; drittens ist bei einem weiter wachsenden Wohlstand davon auszugehen, dass vom individuellen Einkommen relativ mehr für Gesundheitsleistungen ausgegeben wird. Gleichzeitig nimmt die Zahl derer ab, die das Gesundheitswesen finanziere...
The Service Industries Journal, 2007
ABSTRACT Being under pressure both from demographic changes in most industrialised countries and ... more ABSTRACT Being under pressure both from demographic changes in most industrialised countries and increasingly scarce financial resources in social security, in the last decade the German hospital sector tried to find some relief in outsourcing of services not belonging to its core competences like IT services, catering and cleaning. However, not all the hopes connected with this strategy have been fulfilled. This paper takes stock of the current situation of outsourcing in the German hospital sector mainly by the size of the institution. It describes the patterns of outsourcing in the sector, looks at the reasons for outsourcing, and describes the experiences with it of the hospitals on the one hand and the service providers on the other. We conclude by expressing our expectations concerning the foreseeable future of outsourcing in the German hospital sector.
Journal of Applied Econometrics, 2007
When Selection into Treatment Is Strong * This paper investigates the method of matching regardin... more When Selection into Treatment Is Strong * This paper investigates the method of matching regarding two crucial implementation choices, the distance measure and the type of algorithm. We implement optimal full matching -a fully efficient algorithm -and present a framework for statistical inference. The implementation uses data from the NLSY79 to study the effect of college education on earnings. We find that decisions regarding the matching algorithm depend on the structure of the data: In the case of strong selection into treatment and treatment effect heterogeneity a full matching seems preferable. If heterogeneity is weak, pair matching suffices.
Health Economics, 2009
This paper examines effects of the German social health insurance system's reference drug program... more This paper examines effects of the German social health insurance system's reference drug program (RDP) for prescription drugs on ex-factory prices. Moreover, we analyze whether manufacturers adapt prices of their products that are not subject to reference pricing as a consequence of changes in reference prices of their products that are subject to reference pricing. We use econometric panel data methods based on a large panel data set of nearly all German prescription drugs on a monthly basis between October 1994 and July 2005. They provide information on ex-factory prices, reference prices, manufacturers, type of prescription drug, and market entries and exits. Our results show that there is no full price adjustment: A 1%-change in reference prices leads to a 0.3%-change in market prices. Price adjustment, however, is fast -it mostly happens in the first month. Furthermore, the first introduction of a reference price reduces market prices of the affected products by approximately 7%. Finally, we observe a significant time effect that is positive in the market without reference prices and negative in the market with reference prices.
Health Economics, 2012
This paper considers the role of ownership form for the financial sustainability of German acute ... more This paper considers the role of ownership form for the financial sustainability of German acute care hospitals over time. We measure financial sustainability by a hospital-specific yearly probability of default (PD) trying to mirror the ability of hospitals to survive in the market in the long run. The results show that private ownership is associated with significantly lower PDs than public ownership. Moreover, path dependence in the PD is substantial but far from 100%, indicating a large number of improvements and deteriorations in financial sustainability over time. Yet, the general public hospitals have the highest path dependence. Overall, this indicates that public hospitals, which are in a poor financial standing, remain in that state or even deteriorate over time, which may be conflicting with financial sustainability.
Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwic... more Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwicklung, medizinisch-technischer Fortschritt und höherer Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Seit 1992 ist ein jährlicher Anstieg der Gesundheitsausgaben von durchschnittlich 3,3% zu verzeichnen. Der durchschnittliche Beitragssatz zur Gesetzlichen Krankenversicherung (GKV) stieg aus diesem Grund in den vergangenen
Deutschland leistet sich ein im internationalen Vergleich hohes Angebot an medizinischer Versorgu... more Deutschland leistet sich ein im internationalen Vergleich hohes Angebot an medizinischer Versorgung. Im Krankenhausbereich weist Deutschland eine um mehr als 50% höhere Bettendichte auf als die OECD-Länder im Durchschnitt. In der OECD ist in den vergangenen 10 Jahren ein massiver Bettenabbau zu beobachten; Deutschland hinkt trotz des hohen Ausgangswerts hinterher. Im niedergelassenen Bereich liegt die Ärztedichte sowohl bei den Fach-
Das Gesundheitswesen ist eine der bedeutendsten Branchen der deutschen Wirtschaft. Die demografis... more Das Gesundheitswesen ist eine der bedeutendsten Branchen der deutschen Wirtschaft. Die demografische Entwicklung, der medizinisch-technische Fortschritt und ein gestiegener Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Es spricht vieles dafür, dass diese Entwicklung sich fortsetzt. Die Gesundheitswirtschaft könnte daher zu einem wichtigen Wachstumsmotor der deutschen Volkswirtschaft werden. Dafür müsste es der
This paper examines the effect of copayments on doctor visits using the German health care reform... more This paper examines the effect of copayments on doctor visits using the German health care reform of 2004 as a natural experiment. In January 2004, copayments of 10 euros for the first doctor visit in each quarter have been introduced for all adults in the statutory health insurance. Individuals covered by private health insurance as well as youths have been
Propensity score matching is a prominent strategy to reduce imbalance in observational studies. H... more Propensity score matching is a prominent strategy to reduce imbalance in observational studies. However, if imbalance is considerable and the control reservoir is small, either one has to match one control to several treated units or, alternatively, discard many treated persons. The first strategy tends to increase standard errors of the estimated treatment effects while the second might produce a
In times of peak demand hospitals may fail to deliver the high standard of treatment quality that... more In times of peak demand hospitals may fail to deliver the high standard of treatment quality that they are able to offer their patients at regular times. To assess the magnitude of these effects, this study analyzes the effects of low staff-to-patients ratios on patient outcomes empirically.We use the variation of patient admissions over time as a proxy for varying
SSRN Electronic Journal, 2000
We analyse the fi nancial performance of small German hospitals based on balance sheet data of ab... more We analyse the fi nancial performance of small German hospitals based on balance sheet data of about 1,000 hospitals in 2007. Measures of fi nancial performance are the earnings before interest, tax, depreciation, and amortisation (EBITDA) and the probability of default (PD). We fi nd that, on average, small hospitals have more fi nancial diffi culties than large ones. However, there is considerable heterogeneity among small hospitals. While small private-for-profi t hospitals tend to perform very well, small public hospitals face considerable fi nancial problems. Apart from ownership, we fi nd that specialisation, less subsidies in absolute terms, and a higher share of lump-sum subsidies are associated with a better fi nancial performance. JEL Classifi cation: I11, I18
SSRN Electronic Journal, 2000
Die Deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; deta... more Die Deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.ddb.de abrufbar.
Health policy (Amsterdam, Netherlands), 2014
Financial soundness will become more and more difficult in the future for all types of hospitals.... more Financial soundness will become more and more difficult in the future for all types of hospitals. This is particularly relevant for gynaecology and obstetrics departments: while some disciplines can expect higher demand due to demographic changes and progress in medicine and medical technology, the inpatient sector for gynaecology and obstetrics is likely to lose patients in line with these trends. In this paper we estimate future demand for gynaecology and obstetrics in Germany and develop a cost model to calculate the average profitability in this discipline. The number of inpatient cases in gynaecology and obstetrics can be expected to decrease by 3.62% between 2007 and 2020 due to the demographic change and a potential shift from inpatient to outpatient services. Small departments within the fields of gynaecology and obstetrics are already incurring heavy losses, and the anticipated decline in cases should increase this financial distress even more. As such, the further centrali...
SSRN Electronic Journal, 2000
Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliograf... more Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.
SSRN Electronic Journal, 2000
Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliograf... more Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.
SSRN Electronic Journal, 2000
Huge underinvestment increases the need for private borrowing in the German hospital sector, the ... more Huge underinvestment increases the need for private borrowing in the German hospital sector, the access to which is partly determined by the probability of default (PD) of individual hospitals. Using ordinary least squares and quantile regression techniques this paper provides first empirical evidence of its kind to evaluate the PD in the hospital sector and its constituent determinants. Based on annual account and medical data from 17% of all German hospitals we find that the current average probability of default amounts to approximately 1.7%, which is slightly higher than the average probability for all German firms. Among other determinants, we find that public ownership significantly increases the risk of default, while private for-profit and private not-for-profit hospitals do not differ. Moreover, demographic change in the form of population growth is confirmed to be relevant for the PD. JEL-Classification: I11, L31.
Der im Oktober 2006 von der Bundesregierung eingebrachte Gesetzesentwurf zur Stärkung des Wettbew... more Der im Oktober 2006 von der Bundesregierung eingebrachte Gesetzesentwurf zur Stärkung des Wettbewerbs in der Gesetzlichen Krankenversicherung (GKV-WSG) sieht die Einführung eines Gesundheitsfonds und die Erhebung von Zusatzprämien bzw. Ausschüttungen an die Versicherten ab 2009 vor. Durch diese Umstellung der Finanzierung der Gesetzlichen Krankenversicherung ist auch mit Verteilungswirkungen zwischen den Bundesländern aus zwei Gründen zu rechnen. Erstens wird durch den
The troubled financing situation of Germany's statutory health insurance (SHI) is a subject ... more The troubled financing situation of Germany's statutory health insurance (SHI) is a subject widely debated in the public. A further reform for 2006 is now in the offing, only three years after the Act on the Modernisation of Statutory Health Insurance came into force. So far, though, little notice has been taken of the need to reform the country's statutory nursing insurance (SNI) - doubtlessly also on account of its smaller volume of contributions compared with SHI. But funding problems similar to those of SHI emerged already back in 1999, the year when expenditure first outstripped revenue. Right now the gap can only be closed with the capital reserve established with the inception of the SNI. But the reserve will be exhausted in only a few years. So it was against this background that a first, albeit modest, reform came in 2005 with the contribution rate being raised by 0.25 percentage points for persons without children. However, no efforts for a lasting solution have ...
Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwic... more Der Gesundheitssektor ist ein wichtiger Motor der deutschen Wirtschaft . Die demografische Entwicklung, medizinisch-technischer Fortschritt und höherer Wohlstand haben dazu geführt, dass die Ausgaben für Gesundheit in den vergangenen Jahrzehnten überproportional gestiegen sind. Seit 1992 ist ein jährlicher Anstieg der Gesundheitsausgaben von durchschnittlich 3,3% zu verzeichnen. Der durchschnittliche Beitragssatz zur Gesetzlichen Krankenversicherung (GKV) stieg aus diesem Grund in den vergangenen 10 Jahren von 12,5% auf 15,5% an. Vieles spricht für weiteres Wachstum der Gesundheitsausgaben: Erstens wirkt die Alterung der Bevölkerung Ausgabensteigernd; zweitens führt der medizinisch-technische Fortschritt zu steigender Nachfrage nach Gesundheitsleistungen; drittens ist bei einem weiter wachsenden Wohlstand davon auszugehen, dass vom individuellen Einkommen relativ mehr für Gesundheitsleistungen ausgegeben wird. Gleichzeitig nimmt die Zahl derer ab, die das Gesundheitswesen finanziere...
The Service Industries Journal, 2007
ABSTRACT Being under pressure both from demographic changes in most industrialised countries and ... more ABSTRACT Being under pressure both from demographic changes in most industrialised countries and increasingly scarce financial resources in social security, in the last decade the German hospital sector tried to find some relief in outsourcing of services not belonging to its core competences like IT services, catering and cleaning. However, not all the hopes connected with this strategy have been fulfilled. This paper takes stock of the current situation of outsourcing in the German hospital sector mainly by the size of the institution. It describes the patterns of outsourcing in the sector, looks at the reasons for outsourcing, and describes the experiences with it of the hospitals on the one hand and the service providers on the other. We conclude by expressing our expectations concerning the foreseeable future of outsourcing in the German hospital sector.
Journal of Applied Econometrics, 2007
When Selection into Treatment Is Strong * This paper investigates the method of matching regardin... more When Selection into Treatment Is Strong * This paper investigates the method of matching regarding two crucial implementation choices, the distance measure and the type of algorithm. We implement optimal full matching -a fully efficient algorithm -and present a framework for statistical inference. The implementation uses data from the NLSY79 to study the effect of college education on earnings. We find that decisions regarding the matching algorithm depend on the structure of the data: In the case of strong selection into treatment and treatment effect heterogeneity a full matching seems preferable. If heterogeneity is weak, pair matching suffices.
Health Economics, 2009
This paper examines effects of the German social health insurance system's reference drug program... more This paper examines effects of the German social health insurance system's reference drug program (RDP) for prescription drugs on ex-factory prices. Moreover, we analyze whether manufacturers adapt prices of their products that are not subject to reference pricing as a consequence of changes in reference prices of their products that are subject to reference pricing. We use econometric panel data methods based on a large panel data set of nearly all German prescription drugs on a monthly basis between October 1994 and July 2005. They provide information on ex-factory prices, reference prices, manufacturers, type of prescription drug, and market entries and exits. Our results show that there is no full price adjustment: A 1%-change in reference prices leads to a 0.3%-change in market prices. Price adjustment, however, is fast -it mostly happens in the first month. Furthermore, the first introduction of a reference price reduces market prices of the affected products by approximately 7%. Finally, we observe a significant time effect that is positive in the market without reference prices and negative in the market with reference prices.
Health Economics, 2012
This paper considers the role of ownership form for the financial sustainability of German acute ... more This paper considers the role of ownership form for the financial sustainability of German acute care hospitals over time. We measure financial sustainability by a hospital-specific yearly probability of default (PD) trying to mirror the ability of hospitals to survive in the market in the long run. The results show that private ownership is associated with significantly lower PDs than public ownership. Moreover, path dependence in the PD is substantial but far from 100%, indicating a large number of improvements and deteriorations in financial sustainability over time. Yet, the general public hospitals have the highest path dependence. Overall, this indicates that public hospitals, which are in a poor financial standing, remain in that state or even deteriorate over time, which may be conflicting with financial sustainability.