Mathias Kifmann - Böcker

This Element discusses the role of the government in the financing and provision of public health care. It summarises core knowledge and findings in the economics literature, giving a state-of-the-art account of public health care. The first section is devoted to health system financing. It provides policy rationales for public health insurance which rely on both equity and efficiency, the co-existence of public and private health insurance, how health systems deal with excess demand, and the effect of health insurance expansion. The second section covers the provision of health care and the effect of policy interventions that aim at improving quality and efficiency, including reimbursement mechanisms, competition, public-private mix, and integrated care. The third section is devoted to the market for pharmaceuticals, focusing on the challenges of regulating on-patent and off-patent markets, and discussing the main incentives for pharmaceutical innovation.

This Element discusses the role of the government in the financing and provision of public health care. It summarises core knowledge and findings in the economics literature, giving a state-of-the-art account of public health care. The first section is devoted to health system financing. It provides policy rationales for public health insurance which rely on both equity and efficiency, the co-existence of public and private health insurance, how health systems deal with excess demand, and the effect of health insurance expansion. The second section covers the provision of health care and the effect of policy interventions that aim at improving quality and efficiency, including reimbursement mechanisms, competition, public-private mix, and integrated care. The third section is devoted to the market for pharmaceuticals, focusing on the challenges of regulating on-patent and off-patent markets, and discussing the main incentives for pharmaceutical innovation.

How can it be avoided that consumers face premium risk, i.e. increases in their premiums when their health status deteriorates? Mathias Kifmann examines how this problem which is a major challenge for private health insurance markets can be solved. Three principal ways to insure premium risk which preserve competition among health insurers are analyzed and compared. Guaranteed renewable contracts ensure premiums independent of changes in the health status by requiring a life-time commitment to an insurer. Premium insurance compensates an increase in premiums if the health status changes. Under community rating, the government rules out risk-based premiums by requiring that insurers set a uniform premium for all insured. Mathias Kifmann pays particular attention to the challenges posed by managed care. He argues that managed care can aggravate the lock-in problem under guaranteed renewable contracts. He demonstrates that an alternative contract is superior to guaranteed renewable contracts. This contract creates incentives for insurers to behave in the interest of consumers by specifying payments upon switching to another insurer. If insurers are community-rated, an important question is whether they should be allowed to offer managed care besides traditional health insurance. The author shows that managed care can be used as a pure risk-selection device under community rating. However, the introduction of managed care can also be to the benefit of everyone. To obtain such welfare gains, it may be necessary to tax some insurance plans and to subsidize others.

Health Economics presents a systematic treatment of the economics of health behavior and health care delivery. Appropriate both for advanced undergraduate and graduate students of economics, this text provides the background required to understand current research, presenting theoretical models as well as empirical evidence and summarizing key results. Without neglecting ethical concerns, modern microeconomic theory is applied to formulate theoretical implications and predictions. Issues discussed include the economic valuation of life and health, moral hazard in health care utilization, supplier-induced demand, the search for remuneration systems with favorable incentives, risk selection in health insurance markets, and technological change in medicine.

die Ausgabendynamik im Gesundheitswesen, der Umgang mit der Gesundheit, die Rolle des Arztes und sein Verhalten, Ineffizienzen in Krankenhäusern und die Anreize zur Risikoselektion im Krankenkassenwettbewerb.