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  1. Looking into the black box of "medical progress"
    rising health expenditures by illness type and age
    Autor*in: Breyer, Friedrich; Lorenz, Normann; Pruckner, Gerald J.; Schober, Thomas
    Erschienen: [2021]
    Verlag:  Department of Economics, Johannes Kepler University of Linz, Linz-Auhof, Austria

    There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses and in which age groups HCE per patient have grown significantly faster than... mehr

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    There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses and in which age groups HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last four years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005-2018. Our results indicate that among decedents in particular the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical progress for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth and also for treatment of mental and behavioral disorders. The pattern of expenditures over age groups shows that among decedents the younger age groups (below 75) exhibit both the highest HCE per capita and the highest expenditure growth over time. For survivors, we find a steady increase in annual per capita HCE over age in both sexes, but the highest growth rates are observed in the age groups between 20 and 50 years.

     
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    Sprache: Englisch
    Medientyp: Buch (Monographie)
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    Weitere Identifier:
    hdl: 10419/246320
    Schriftenreihe: Working paper / Department of Economics, Johannes Kepler University of Linz ; no. 2103 (January 2021)
    Schlagworte: health care expenditures; medical progress; cost of dying
    Umfang: 1 Online-Ressource (circa 29 Seiten), Illustrationen
  2. Aging and health care expenditure
    a nonparametric approach
    Autor*in: Lorenz, Normann; Ihle, Peter; Breyer, Friedrich
    Erschienen: May 25, 2020
    Verlag:  Verein für Socialpolitik, [Köln]

    One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will increase per-capita health care expenditures (HCE). Proponents of the "red-herring hypothesis"... mehr

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    One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will increase per-capita health care expenditures (HCE). Proponents of the "red-herring hypothesis" argue that this is not the case because most of the correlation of age and HCE is due to the compression of the mortality rate in old age and the high costs of dying. The evidence for this hypothesis is, however, mixed. Our contribution to this debate is mainly methodological: We argue that the relationship of age, time to death (TTD) and HCE should be estimated non-parametrically. Using a large panel data set from the German Statutory Health Insurance, we demonstrate that the non-parametric approach is particularly useful to answer the question whether age still has an impact on HCE once TTD is taken into account and find that it is clearly the case. This relationship is even more pronounced for long-term care expenditures (LTCE). We then show that the age-expenditure relationship is not stable over time: for many age classes, HCE in the last year of life grow considerably faster than HCE of survivors. We explore the impact of these findings on the simulation of future HCE and find that population aging will in fact contribute to rising HCE in the coming decades. However, the total impact of demographics on future HCE and LTCE is dwarfed by the exogenous time trend, which is due to medical progress and increasing generosity of public LTC insurance.

     
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    Weitere Identifier:
    hdl: 10419/224635
    Schriftenreihe: Jahrestagung 2020 / Verein für Socialpolitik ; 133
    Schlagworte: health care expenditures; aging; red-herring hypothesis; non-parametric regression
    Umfang: 1 Online-Ressource (circa 23 Seiten), Illustrationen
  3. Looking into the black box of "medical progress"
    rising health expenditures by illness type and age
    Autor*in: Breyer, Friedrich; Lorenz, Normann; Pruckner, Gerald J.; Schober, Thomas
    Erschienen: January 2021
    Verlag:  Johannes Kepler University, Department of Economics, Austria, Linz, Austria

    There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses and in which age groups HCE per patient have grown significantly faster than... mehr

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    Resolving-System (kostenfrei)

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    ZBW - Leibniz-Informationszentrum Wirtschaft, Standort Kiel
    Signatur:
    DS 511
    Fernleihe:
    keine Fernleihe

     

    There is agreement among health economists that on the whole medical innovation causes health care expenditures (HCE) to rise. This paper analyzes for which diagnoses and in which age groups HCE per patient have grown significantly faster than average HCE. We distinguish decedents (patients in their last four years of life) from survivors and use a unique dataset comprising detailed HCE of all members of a regional health insurance fund in Upper Austria for the period 2005-2018. Our results indicate that among decedents in particular the expenditures for treatment of neoplasms have exceeded the general trend in HCE. This confirms that medical progress for this group of diseases has been particularly strong over the last 15 years. For survivors, we find a noticeable growth in cases and cost per case for pregnancies and childbirth and also for treatment of mental and behavioral disorders. The pattern of expenditures over age groups shows that among decedents the younger age groups (below 75) exhibit both the highest HCE per capita and the highest expenditure growth over time. For survivors, we find a steady increase in annual per capita HCE over age in both sexes, but the highest growth rates are observed in the age groups between 20 and 50 years.

     
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    Sprache: Englisch
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    Weitere Identifier:
    hdl: 10419/231468
    Schriftenreihe: Working paper / Christian Doppler Laboratory Aging, Health, and the Labor Market ; [21,01]
    Schlagworte: health care expenditures; medical progress; cost of dying
    Umfang: 1 Online-Ressource (circa 29 Seiten), Illustrationen
  4. The "red herring" after 20 years
    ageing and health care expenditures
    Autor*in: Breyer, Friedrich; Lorenz, Normann
    Erschienen: [2019]
    Verlag:  CESifo, Center for Economic Studies & Ifo Institute, Munich, Germany

    20 years ago, Zweifel, Felder and Meier (1999) established the by now famous "red-herring" hypothesis, according to which population ageing does not lead to an increase in per capita health care expenditures (HCE) because the observed positive... mehr

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    20 years ago, Zweifel, Felder and Meier (1999) established the by now famous "red-herring" hypothesis, according to which population ageing does not lead to an increase in per capita health care expenditures (HCE) because the observed positive correlation between age and health care expenditures (HCE) in cross-sectional data is exclusively due to the facts that mortality rises with age and a large share of HCE is caused by proximity to death. This hypothesis has spurned a large and still growing literature on the causes and consequences of growing HCE in OECD countries, but the results of empirical studies have been rather mixed. In light of the imminent population ageing in many of these countries it is still being discussed whether unfunded social health insurance systems will be sustainable, in particular as long as they promise to provide universal and unlimited access to medical care including the latest advances. In this paper, we present a critical survey of the empirical literature of the past 20 years on this topic and draw some preliminary conclusions regarding the policy question mentioned above. In doing so we distinguish four different versions of the red herring hypothesis and derive the logical connections between them. This will help to understand what empirical findings are suitable to derive predictions on the future sustainability of HCE.

     
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    Weitere Identifier:
    hdl: 10419/214953
    Schriftenreihe: Array ; no. 7951 (November 2019)
    Umfang: 1 Online-Ressource (circa 23 Seiten), Illustrationen
  5. Aging and health care expenditures
    a non-parametric approach
    Autor*in: Lorenz, Normann; Ihle, Peter; Breyer, Friedrich
    Erschienen: April 2020
    Verlag:  CESifo, Center for Economic Studies & Ifo Institute, Munich, Germany

    One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will place an additional burden on the tax payers who finance public health care systems. Proponents... mehr

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    DS 63
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    One of the most important controversies in health economics concerns the question whether the imminent aging of the population in most OECD countries will place an additional burden on the tax payers who finance public health care systems. Proponents of the “red-herring hypothesis” argue that this is not the case because most of the correlation of age and health care expenditures (HCE) is due to the fact that the mortality rate rises with age and HCE rise steeply in the last years before death. The evidence regarding this hypothesis is, however, mixed. Our contribution to this debate is mainly methodological: We argue that the relationship of age, time to death (TTD) and HCE should be estimated non-parametrically. Using a large panel data set from the German Statutory Health Insurance, we first show that the parametric approach overestimates the expenditures of the high age classes and thus overstates the increase of future HCE due to aging. Secondly, we show that the non-parametric approach is particularly useful to answer the question whether age still has an impact on HCE once TTD is taken into account and find that it is clearly the case. This relationship is even more pronounced for long-term care expenditures (LTCE). We then show that the age-expenditure relationship is not stable over time: for many age classes, HCE in the last year of life grow considerably faster than HCE of survivors. We explore the impact of these findings on the simulation of future HCE and find that population aging will in fact contribute to rising HCE in the coming decades. We also find that the impact of different population projections provided by the statistical offices has a greater impact on these simulations than previously acknowledged. However, the total impact of demographics on future HCE and LTCE is dwarfed by the exogenous time trend, which is due to medical progress and increasing generosity of public LTC insurance.

     
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    Sprache: Englisch
    Medientyp: Buch (Monographie)
    Format: Online
    Weitere Identifier:
    hdl: 10419/216612
    Schriftenreihe: CESifo working paper ; no. 8216 (2020)
    Umfang: 1 Online-Ressource (circa 24 Seiten), Illustrationen
  6. The dead-anyway effect revis(it)ed
    Autor*in: Breyer, Friedrich; Felder, Stefan
    Erschienen: 2002
    Verlag:  Univ., FEMM, Magdeburg

    Standort:
    Universität Potsdam, Universitätsbibliothek
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    uneingeschränkte Fernleihe, Kopie und Ausleihe
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    Sprache: Englisch
    Medientyp: Buch (Monographie)
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    Schriftenreihe: Working paper series / Otto von Guericke University, FEMM, Faculty of Economics and Management ; 2002,10
    Schlagworte: Zahlungsbereitschaftsanalyse; Erwartungsnutzen; Sterblichkeit; Risiko; Erbe; Theorie
    Umfang: 12 S
    Bemerkung(en):

    Literaturverz. S. 10
  7. Lebenserwartung und Gesundheitsausgaben im 21. Jahrhundert
    eine neue Berechnung unter Berücksichtigung der Sterbekosten
    Autor*in: Breyer, Friedrich; Felder, Stefan
    Erschienen: 2004
    Verlag:  Univ., FEMM, Magdeburg

    Standort:
    Universität Potsdam, Universitätsbibliothek
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    uneingeschränkte Fernleihe, Kopie und Ausleihe
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    Quelle: Verbundkataloge
    Sprache: Deutsch
    Medientyp: Buch (Monographie)
    Format: Druck
    Schriftenreihe: Working paper series / Otto von Guericke University, FEMM, Faculty of Economics and Management ; 2004,5
    Schlagworte: Sterblichkeit; Kosten; Gesundheitskosten; Prognose; Deutschland
    Umfang: 15 S, graph. Darst
  8. Incentives to retire later
    a solution to the social security crisis?
    Autor*in: Breyer, Friedrich; Kifmann, Mathias
    Erschienen: 2001
    Verlag:  DIW, Berlin

    As one possible solution to the well-known financing crisis of unfunded social security systems, an increase in the retirement age is a popular option. To induce workers to retire later, it has been proposed to strengthen the link between retirement... mehr

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    Leibniz-Institut für Wirtschaftsforschung Halle, Bibliothek
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    As one possible solution to the well-known financing crisis of unfunded social security systems, an increase in the retirement age is a popular option. To induce workers to retire later, it has been proposed to strengthen the link between retirement age and benefit level. The present paper is devoted to analyzing the long-run financial implications of such a reform. We show that with actuarial adjustments the long-run contribution rate is an increasing function of the retirement age chosen by workers. Moreover, the implicit tax paid to the pension system by a participant can increase in the long run if the retirement age rises in response to a "steep" adjustment rule. In this sense, the proposed "cure" may worsen the disease. Finally, we propose an alternative adjustment scheme which avoids these negative consequences. Finally, we show how the negative effects can be avoided by forming a capital stock from the additional revenues due to later retirement.

     
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    Quelle: Verbundkataloge
    Sprache: Englisch
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    Schriftenreihe: Diskussionspapier / Deutsches Institut für Wirtschaftsforschung ; 266
    Schlagworte: Altersgrenze; Arbeitsangebot; Anreiz; Gesetzliche Rentenversicherung; Umlageverfahren; Äquivalenzprinzip; Theorie; Deutschland
    Umfang: 26 S, graph. Darst, b
    Bemerkung(en):

    Zsfassung in dt. Sprache
  9. Demographic change, endogenous labor supply and the political feasibility of pension reform
    Autor*in: Breyer, Friedrich; Stolte, Klaus
    Erschienen: 2000
    Verlag:  DIW, Berlin

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    Leibniz-Institut für Wirtschaftsforschung Halle, Bibliothek
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    Mag5768
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    Sprache: Englisch
    Medientyp: Buch (Monographie)
    Format: Druck
    RVK Klassifikation: QB 910 ; QX 400
    Schriftenreihe: Diskussionspapier / Deutsches Institut für Wirtschaftsforschung ; 202
    Schlagworte: Rentenreform; Ökonomische Theorie der Demokratie; Arbeitsangebot; Overlapping Generations; Rentenfinanzierung; Umlageverfahren; Theorie; Alternde Bevölkerung
    Umfang: 19 S, Tab., b
  10. Is there a "dead-anyway" effect in willingness to pay for risk reduction?
    Autor*in: Breyer, Friedrich; Grabka, Markus M.
    Erschienen: 2001
    Verlag:  DIW, Berlin

    Standort:
    Leibniz-Institut für Wirtschaftsforschung Halle, Bibliothek
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    Mag14614
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    Sprache: Englisch
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    Schriftenreihe: Discussion paper / Deutsches Institut für Wirtschaftsforschung ; 252
    Schlagworte: Zahlungsbereitschaftsanalyse; Risiko; Sterblichkeit; Vermögen; Lebensqualität; Theorie; Deutschland; Australien; Lebenszufriedenheit
    Umfang: 18 S, Tab., b
    Bemerkung(en):

    Zsfassung in dt. Sprache
  11. Income redistribution and the political economy of social health insurance
    comparing Germany and Switzerland
    Autor*in: Breyer, Friedrich
    Erschienen: 2001
    Verlag:  DIW, Berlin

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    ZBW - Leibniz-Informationszentrum Wirtschaft, Standort Kiel
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    RVK Klassifikation: QB 910
    Schriftenreihe: Discussion paper / Deutsches Institut für Wirtschaftsforschung ; 253
    Schlagworte: Gesetzliche Krankenversicherung; Umverteilung; Gesundheitsfinanzierung; Gesundheitskosten; Abstimmungsregel; Ökonomische Theorie der Demokratie; Theorie; Deutschland; Schweiz
    Umfang: 12 Bl, graph. Darst
  12. Why funding is not a solution to the "social security crisis"
    Autor*in: Breyer, Friedrich
    Erschienen: 2001
    Verlag:  DIW, Berlin

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    RVK Klassifikation: QB 910
    Schriftenreihe: Discussion paper / Deutsches Institut für Wirtschaftsforschung ; 254
    Schlagworte: Gesetzliche Rentenversicherung; Kapitaldeckungsverfahren; Pareto-Optimum; Kritik; Theorie; Pension trusts; Social security
    Umfang: 8 Bl
    Bemerkung(en):

    Zsfassung in dt. Sprache
  13. Einkommensbezogene versus pauschale GKV-Beiträge : eine Begriffsklärung
    Autor*in: Breyer, Friedrich
    Erschienen: 2003
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  14. Demographic change, endogenous labor supply and the political feasibility of pension reform
    Autor*in: Breyer, Friedrich; Stolte, Klaus
    Erschienen: 2000
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  15. Is there a "dead-anyway" effect in willingness to pay for risk reduction?
    Autor*in: Breyer, Friedrich; Grabka, Markus M.
    Erschienen: 2001
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  16. Income redistribution and the political economy of social health insurance : comparing Germany and Switzerland
    Autor*in: Breyer, Friedrich
    Erschienen: 2001
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  17. Why Funding is not a Solution to the "Social Security Crisis"
    Autor*in: Breyer, Friedrich
    Erschienen: 2001
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  18. Incentives to retire later : a solution to the social security crisis?
    Autor*in: Breyer, Friedrich; Kifmann, Mathias
    Erschienen: 2001
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  19. The dead anyway effect revis(it)ed
    Autor*in: Breyer, Friedrich; Felder, Stefan
    Erschienen: 2002
    Verlag:  Deutsches Institut für Wirtschaftsforschung (DIW), Berlin

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  20. The dead anyway effect revis(it)ed
    Autor*in: Breyer, Friedrich; Felder, Stefan
    Erschienen: 2002
    Verlag:  Univ., FEMM, Magdeburg

  21. Demographic change, endogenous labor supply and the political feasibility of pension reform
    Autor*in: Breyer, Friedrich; Stolte, Klaus
    Erschienen: 2000
    Verlag:  DIW, Berlin

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  22. Health care reform
    separating insurance from income redistribution
    Autor*in: Breyer, Friedrich; Haufler, Andreas
    Erschienen: 2000
    Verlag:  DIW, Berlin

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  23. The German retirement benefit formula
    drawbacks and alternatives = Die Rentenformel in der gesetzlichen Rentenversicherung : Nachteile und Alternativen
    Autor*in: Breyer, Friedrich; Kifmann, Mathias
    Erschienen: 2003
    Verlag:  DIW, Berlin

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  24. Einkommensbezogene versus pauschale GKV-Beiträge
    eine Begriffsklärung
    Autor*in: Breyer, Friedrich
    Erschienen: 2003
    Verlag:  DIW, Berlin

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  25. The dead anyway effect revis(it)ed
    Autor*in: Breyer, Friedrich; Felder, Stefan
    Erschienen: 2002
    Verlag:  DIW, Berlin

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