Florian Buchner - Academia.edu (original) (raw)

Papers by Florian Buchner

Competitive social health insurance systems (at least) in Western Europe have implemented systems... more Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R2 as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implem...

Gesundheits- und Sozialpolitik, 2016

essentials, 2016

Das Lernen durch Herausforderung wird vielen Anforderungen an eine zeitgemase Didaktik gerecht, d... more Das Lernen durch Herausforderung wird vielen Anforderungen an eine zeitgemase Didaktik gerecht, die sich durch wissenschaftliche Erkenntnisse aus verschiedenen Forschungsgebieten rund um das Thema Lernen und Lehren ergeben. Wir blicken dazu in den folgenden Abschnitten auf Forschungsergebnisse aus den Neurowissenschaften und die Anforderungen an gehirngerechtes Lernen (Abschn. 9.1), sowie auf die Grundprinzipien einer modernen, studierendenzentrierten Didaktik (Abschn. 9.2) und Erkenntnisse aus der Motivationsforschung (Abschn. 9.3).

essentials, 2016

Die Basis des herausforderungsbasierten Lernmodells stellt der in Abb. 3.1 dargestellte „Challeng... more Die Basis des herausforderungsbasierten Lernmodells stellt der in Abb. 3.1 dargestellte „Challenge-Feedback-Lernkreis“ dar. Er beginnt mit einer Herausforderung („challenge“), die vonseiten des/der Lehrenden an die Studierenden gestellt wird. Diese Herausforderung wird aus den Lernzielen abgeleitet.

essentials, 2016

Im Bereich der Hochschuldidaktik wird vielfach ein Paradigmenwechsel „vom Lehren zum Lernen“ besc... more Im Bereich der Hochschuldidaktik wird vielfach ein Paradigmenwechsel „vom Lehren zum Lernen“ beschworen. Es geht dabei um eine grundlegende Neuorientierung, weg von einem Fokus auf die Wissensvermittlung durch die Lehrperson, hin zum Schaffen von Rahmenbedingungen, unter denen Studierende selbst Wissen entdecken und Problemlosungsfahigkeiten erwerben konnen. Wissensvermittlung wird durch Kompetenzvermittlung ersetzt bzw. im besseren Falle erganzt. Die Rolle des Lehrenden wandelt sich vom Vortragenden zum „Lernbegleiter“ – und in unserem Konzept auch zum „Herausforderer“.

essentials, 2016

Lehr- und Lernansatze, die fur das Lernen der ersten Stufen (also im Grundlagenbereich) gut geeig... more Lehr- und Lernansatze, die fur das Lernen der ersten Stufen (also im Grundlagenbereich) gut geeignet sind, sind nicht notwendigerweise in gleicher Weise fur das Lehren und Lernen bei fortgeschrittenem Wissensniveau oder Methodenkenntnissen geeignet. Die Anwendung von Lernen durch Herausforderung ist insbesondere dort sinnvoll, wo schon inhaltliche und methodische Kenntnisse vorausgesetzt werden konnen, die dann zur Bearbeitung oder Losung der Herausforderung eingesetzt werden konnen.

essentials, 2016

einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung, die nicht ausd... more einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung, die nicht ausdrücklich vom Urheberrechtsgesetz zugelassen ist, bedarf der vorherigen Zustimmung des Verlags. Das gilt insbesondere für Vervielfältigungen, Bearbeitungen, Übersetzungen, Mikroverfilmungen und die Einspeicherung und Verarbeitung in elektronischen Systemen. Die Wiedergabe von Gebrauchsnamen, Handelsnamen, Warenbezeichnungen usw. in diesem Werk berechtigt auch ohne besondere Kennzeichnung nicht zu der Annahme, dass solche Namen im Sinne der Warenzeichen-und Markenschutz-Gesetzgebung als frei zu betrachten wären und daher von jedermann benutzt werden dürften. Der Verlag, die Autoren und die Herausgeber gehen davon aus, dass die Angaben und Informationen in diesem Werk zum Zeitpunkt der Veröffentlichung vollständig und korrekt sind. Weder der Verlag noch die Autoren oder die Herausgeber übernehmen, ausdrücklich oder implizit, Gewähr für den Inhalt des Werkes, etwaige Fehler oder Äußerungen. Gedruckt auf säurefreiem und chlorfrei gebleichtem Papier Springer Gabler ist Teil von Springer Nature Die eingetragene Gesellschaft ist Springer Fachmedien Wiesbaden GmbH Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.

Health Policy, 2013

Context: From the mid-1990s several countries have introduced elements of regulated competition i... more Context: From the mid-1990s several countries have introduced elements of regulated competition in healthcare. The aim of this paper is to identify the most important preconditions for achieving efficiency and affordability under regulated competition in healthcare, and to indicate to what extent these preconditions are fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland. These experiences can be worthwhile for other countries (considering) implementing regulated competition (e.g. Australia, Czech Republic, Ireland, Russia, Slovakia, US). Methods: We identify and discuss ten preconditions derived from the theoretical model of regulated competition and assess the extent to which each of these preconditions is fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland. Findings: After more than a decade of healthcare reforms in none of these countries all preconditions are completely fulfilled. The following preconditions are least fulfilled: consumer information and transparency, contestable markets, freedom to contract and integrate, and competition regulation. The extent to which the preconditions are fulfilled differs substantially across the five countries. Despite substantial progress in the last years in improving the risk equalization systems, insurers are still confronted with substantial incentives for risk selection, in particular in Israel and Switzerland. Imperfect risk adjustment implies that governments are faced with a complex tradeoff between efficiency, affordability and selection. Conclusions: Implementing regulated competition in healthcare is complex, given the preconditions that have to be fulfilled. Moreover, since not all preconditions can be fulfilled simultaneously, tradeoffs have to be made with implications for the levels of efficiency and affordability that can be achieved. Therefore the optimal set of preconditions is not only an empirical question but ultimately also a matter of societal preferences.

Health Policy, 2003

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a g... more From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds.

The Risk Adjustment Reform Act of 2001 mandates that a health-status-based risk adjustment mechan... more The Risk Adjustment Reform Act of 2001 mandates that a health-status-based risk adjustment mechanism has to be implemented in Germany's Statutory Health Insurance system by January 1, 2007. German parliament decided this as with the existing demographic risk adjustment model, that means there is cream skimming and sickness funds hesitate to engage in managing care for the chronical ill. Four

Jahrbücher für Nationalökonomie und Statistik, 2007

Health care systems are financed through a mixture of different components: taxes, contributions ... more Health care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive – which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, form healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

Health Policy, 2016

Competitive social health insurance systems (at least) in Western Europe have implemented systems... more Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases.

Health economics, Jan 26, 2015

Risk equalization formulas have been refined since their introduction about two decades ago. Beca... more Risk equalization formulas have been refined since their introduction about two decades ago. Because of the complexity and the abundance of possible interactions between the variables used, hardly any interactions are considered. A regression tree is used to systematically search for interactions, a methodologically new approach in risk equalization. Analyses are based on a data set of nearly 2.9 million individuals from a major German social health insurer. A two-step approach is applied: In the first step a regression tree is built on the basis of the learning data set. Terminal nodes characterized by more than one morbidity-group-split represent interaction effects of different morbidity groups. In the second step the 'traditional' weighted least squares regression equation is expanded by adding interaction terms for all interactions detected by the tree, and regression coefficients are recalculated. The resulting risk adjustment formula shows an improvement in the adjust...

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.

Zeitschrift für die gesamte Versicherungswissenschaft, 2000

Competitive social health insurance systems (at least) in Western Europe have implemented systems... more Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R2 as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implem...

Gesundheits- und Sozialpolitik, 2016

essentials, 2016

Das Lernen durch Herausforderung wird vielen Anforderungen an eine zeitgemase Didaktik gerecht, d... more Das Lernen durch Herausforderung wird vielen Anforderungen an eine zeitgemase Didaktik gerecht, die sich durch wissenschaftliche Erkenntnisse aus verschiedenen Forschungsgebieten rund um das Thema Lernen und Lehren ergeben. Wir blicken dazu in den folgenden Abschnitten auf Forschungsergebnisse aus den Neurowissenschaften und die Anforderungen an gehirngerechtes Lernen (Abschn. 9.1), sowie auf die Grundprinzipien einer modernen, studierendenzentrierten Didaktik (Abschn. 9.2) und Erkenntnisse aus der Motivationsforschung (Abschn. 9.3).

essentials, 2016

Die Basis des herausforderungsbasierten Lernmodells stellt der in Abb. 3.1 dargestellte „Challeng... more Die Basis des herausforderungsbasierten Lernmodells stellt der in Abb. 3.1 dargestellte „Challenge-Feedback-Lernkreis“ dar. Er beginnt mit einer Herausforderung („challenge“), die vonseiten des/der Lehrenden an die Studierenden gestellt wird. Diese Herausforderung wird aus den Lernzielen abgeleitet.

essentials, 2016

Im Bereich der Hochschuldidaktik wird vielfach ein Paradigmenwechsel „vom Lehren zum Lernen“ besc... more Im Bereich der Hochschuldidaktik wird vielfach ein Paradigmenwechsel „vom Lehren zum Lernen“ beschworen. Es geht dabei um eine grundlegende Neuorientierung, weg von einem Fokus auf die Wissensvermittlung durch die Lehrperson, hin zum Schaffen von Rahmenbedingungen, unter denen Studierende selbst Wissen entdecken und Problemlosungsfahigkeiten erwerben konnen. Wissensvermittlung wird durch Kompetenzvermittlung ersetzt bzw. im besseren Falle erganzt. Die Rolle des Lehrenden wandelt sich vom Vortragenden zum „Lernbegleiter“ – und in unserem Konzept auch zum „Herausforderer“.

essentials, 2016

Lehr- und Lernansatze, die fur das Lernen der ersten Stufen (also im Grundlagenbereich) gut geeig... more Lehr- und Lernansatze, die fur das Lernen der ersten Stufen (also im Grundlagenbereich) gut geeignet sind, sind nicht notwendigerweise in gleicher Weise fur das Lehren und Lernen bei fortgeschrittenem Wissensniveau oder Methodenkenntnissen geeignet. Die Anwendung von Lernen durch Herausforderung ist insbesondere dort sinnvoll, wo schon inhaltliche und methodische Kenntnisse vorausgesetzt werden konnen, die dann zur Bearbeitung oder Losung der Herausforderung eingesetzt werden konnen.

essentials, 2016

einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung, die nicht ausd... more einschließlich aller seiner Teile ist urheberrechtlich geschützt. Jede Verwertung, die nicht ausdrücklich vom Urheberrechtsgesetz zugelassen ist, bedarf der vorherigen Zustimmung des Verlags. Das gilt insbesondere für Vervielfältigungen, Bearbeitungen, Übersetzungen, Mikroverfilmungen und die Einspeicherung und Verarbeitung in elektronischen Systemen. Die Wiedergabe von Gebrauchsnamen, Handelsnamen, Warenbezeichnungen usw. in diesem Werk berechtigt auch ohne besondere Kennzeichnung nicht zu der Annahme, dass solche Namen im Sinne der Warenzeichen-und Markenschutz-Gesetzgebung als frei zu betrachten wären und daher von jedermann benutzt werden dürften. Der Verlag, die Autoren und die Herausgeber gehen davon aus, dass die Angaben und Informationen in diesem Werk zum Zeitpunkt der Veröffentlichung vollständig und korrekt sind. Weder der Verlag noch die Autoren oder die Herausgeber übernehmen, ausdrücklich oder implizit, Gewähr für den Inhalt des Werkes, etwaige Fehler oder Äußerungen. Gedruckt auf säurefreiem und chlorfrei gebleichtem Papier Springer Gabler ist Teil von Springer Nature Die eingetragene Gesellschaft ist Springer Fachmedien Wiesbaden GmbH Die Deutsche Nationalbibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über http://dnb.d-nb.de abrufbar.

Health Policy, 2013

Context: From the mid-1990s several countries have introduced elements of regulated competition i... more Context: From the mid-1990s several countries have introduced elements of regulated competition in healthcare. The aim of this paper is to identify the most important preconditions for achieving efficiency and affordability under regulated competition in healthcare, and to indicate to what extent these preconditions are fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland. These experiences can be worthwhile for other countries (considering) implementing regulated competition (e.g. Australia, Czech Republic, Ireland, Russia, Slovakia, US). Methods: We identify and discuss ten preconditions derived from the theoretical model of regulated competition and assess the extent to which each of these preconditions is fulfilled in Belgium, Germany, Israel, the Netherlands and Switzerland. Findings: After more than a decade of healthcare reforms in none of these countries all preconditions are completely fulfilled. The following preconditions are least fulfilled: consumer information and transparency, contestable markets, freedom to contract and integrate, and competition regulation. The extent to which the preconditions are fulfilled differs substantially across the five countries. Despite substantial progress in the last years in improving the risk equalization systems, insurers are still confronted with substantial incentives for risk selection, in particular in Israel and Switzerland. Imperfect risk adjustment implies that governments are faced with a complex tradeoff between efficiency, affordability and selection. Conclusions: Implementing regulated competition in healthcare is complex, given the preconditions that have to be fulfilled. Moreover, since not all preconditions can be fulfilled simultaneously, tradeoffs have to be made with implications for the levels of efficiency and affordability that can be achieved. Therefore the optimal set of preconditions is not only an empirical question but ultimately also a matter of societal preferences.

Health Policy, 2003

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a g... more From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds.

The Risk Adjustment Reform Act of 2001 mandates that a health-status-based risk adjustment mechan... more The Risk Adjustment Reform Act of 2001 mandates that a health-status-based risk adjustment mechanism has to be implemented in Germany's Statutory Health Insurance system by January 1, 2007. German parliament decided this as with the existing demographic risk adjustment model, that means there is cream skimming and sickness funds hesitate to engage in managing care for the chronical ill. Four

Jahrbücher für Nationalökonomie und Statistik, 2007

Health care systems are financed through a mixture of different components: taxes, contributions ... more Health care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive – which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, form healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

Health Policy, 2016

Competitive social health insurance systems (at least) in Western Europe have implemented systems... more Competitive social health insurance systems (at least) in Western Europe have implemented systems of morbidity based risk adjustment to set a level playing field for insurers. However, many high cost insured still are heavily underfunded despite risk adjustment, leaving incentives for risk selection. In most of these health care systems, there is an ongoing debate about how to deal with such underpaid high cost cases. This study develops four distinct concepts by adding variables to risk adjustment or by setting up a high cost pool for underpaid insured besides the risk adjustment system. Their features, incentives and distributional effects are discussed. With a data set of 6 million insured, performance is demonstrated for Germany. All models achieve a substantial improvement in model fit, measured in terms of R(2) as well as CPM. As the results of the various models are different in different dimensions, the trade-offs that have to be dealt with and should be addressed, when implementing a model to reduce underfunding of high cost cases.

Health economics, Jan 26, 2015

Risk equalization formulas have been refined since their introduction about two decades ago. Beca... more Risk equalization formulas have been refined since their introduction about two decades ago. Because of the complexity and the abundance of possible interactions between the variables used, hardly any interactions are considered. A regression tree is used to systematically search for interactions, a methodologically new approach in risk equalization. Analyses are based on a data set of nearly 2.9 million individuals from a major German social health insurer. A two-step approach is applied: In the first step a regression tree is built on the basis of the learning data set. Terminal nodes characterized by more than one morbidity-group-split represent interaction effects of different morbidity groups. In the second step the 'traditional' weighted least squares regression equation is expanded by adding interaction terms for all interactions detected by the tree, and regression coefficients are recalculated. The resulting risk adjustment formula shows an improvement in the adjust...

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.

Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch ge... more Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.

Zeitschrift für die gesamte Versicherungswissenschaft, 2000