Göpffarth Dirk, Kopetsch Thomas, Schmitz Hendrik
Staatskanzlei NRW, Germany.
KBV, Berlin, Germany.
Health Econ. 2016 Jul;25(7):801-15. doi: 10.1002/hec.3183. Epub 2015 May 12.
Health care expenditure in Germany shows clear regional differences. Such geographic variations are often seen as an indicator for inefficiency. With its homogeneous health care system, low co-payments and uniform prices, Germany is a particularly suited example to analyse regional variations. We use data for the year 2011 on expenditure, utilization of health services and state of health in Germany's statutory health insurance system. This data, which originate from a variety of administrative sources and cover about 90% of the population, are enriched with a wealth of socio-economic variables, data on pollutants, prices and individual preferences. State of health and demography explains 55% of the differences as measured by the standard deviation while all control variables account for a total of 72% of the differences at county level. With other measures of variation, we can account for an even greater proportion. A higher proportion of variation than usually supposed can thus be explained. Whilst this study cannot quantify inefficiencies, our results contradict the thesis that regional variations reflect inefficiency. Copyright © 2015 John Wiley & Sons, Ltd.
德国的医疗保健支出存在明显的地区差异。这种地理差异通常被视为效率低下的一个指标。德国拥有同质化的医疗保健系统、低自付费用和统一价格，是分析地区差异的一个特别合适的例子。我们使用了2011年德国法定医疗保险系统中关于支出、医疗服务利用情况和健康状况的数据。这些数据源自各种行政来源，覆盖了约90%的人口，并丰富了大量社会经济变量、污染物数据、价格和个人偏好数据。健康状况和人口统计学解释了标准差所衡量差异的55%，而所有控制变量在县一级总共解释了差异的72%。采用其他差异衡量方法时，我们能解释的比例甚至更高。因此，可以解释的差异比例比通常认为的要高。虽然本研究无法量化低效率情况，但我们的结果与地区差异反映低效率这一论点相矛盾。版权所有© 2015 约翰·威利父子有限公司。
