It is still an open question whether increasing life expectancy as such causes higher health care expenditures (HCE) in a population. According to the ''red herring'' hypothesis, the positive correlation between age and HCE is exclusively due to the fact that mortality rises with age and a large share of HCE is caused by proximity to death. As a consequence, rising longevity through falling mortality rates may even reduce HCE. However, a weakness of many previous empirical studies is that they use cross-sectional evidence to make inferences on a development over time. In this paper, we analyse the impact of rising longevity on the trend of HCE over time by using data from a pseudo-panel of German sickness fund members over the period 1997 2009. Using (dynamic) panel data models, we find that age, mortality and 5-year survival rates each have a positive impact on per-capita HCE. Our explanation for the last finding is that physicians treat patients more aggressively if the results of these treatments pay off over a longer time span, which we call ''Eubie Blake effect''. A simulation on the basis of an official population forecast for Germany is used to isolate the effect of demographic ageing on real per-capita HCE over the coming decades. We find that, while falling mortality rates as such lower HCE, this effect is more than compensated by an increase in remaining life expectancy so that the net effect of ageing on HCE over time is clearly positive.

We derive a simple sufficient-statistics test for whether a nonlinear tax-transfer system is second-best Pareto efficient. If it is not, it is beyond the top of the Laffer curve and there exists a tax cut that is self-financing. The test depends on the income distribution, extensive and intensive labor supply elasticities, and income effect parameters.A tax-transfer system is likely to be inefficient if marginal tax rates are quickly falling in income. We apply this test to the German tax-transfer system and find the structure of effective marginal tax rates likely to be inefficient in the region where transfers are phased-out.

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In many countries, social health insurance systems are being reformed in favor of more competition among insurers, while premiums are community rated by regulation. The implicit incentives for insurers to engage in risk selection can only be curtailed using appropriate systems of risk-adjusted equalization payments among insurers. To develop these systems, predictors of individual utilization patterns have to be identified, e.g. via regression analysis using previous utilization data. In some countries such as Germany, such data are hardly ever available. In the early nineties, a number of sickness funds participated in an experiment in which individual utilization data were collected. Our data set covers more than 70,000 members of company sickness funds over a 5-year period. We analyze socio-demographic determinants of utilization which could be used as risk adjusters in a risk equalization scheme. Our results suggest that besides age and sex, the set of risk adjusters should include income, family status and a dummy for the last year of life.

It is still an open question whether increasing life expectancy as such causes higher health care expenditures (HCE) in a population. According to the ''red herring'' hypothesis, the positive correlation between age and HCE is exclusively due to the fact that mortality rises with age and a large share of HCE is caused by proximity to death. As a consequence, rising longevity through falling mortality rates may even reduce HCE. However, a weakness of many previous empirical studies is that they use cross-sectional evidence to make inferences on a development over time. In this paper, we analyse the impact of rising longevity on the trend of HCE over time by using data from a pseudo-panel of German sickness fund members over the period 1997 2009. Using (dynamic) panel data models, we find that age, mortality and 5-year survival rates each have a positive impact on per-capita HCE. Our explanation for the last finding is that physicians treat patients more aggressively if the results of these treatments pay off over a longer time span, which we call ''Eubie Blake effect''. A simulation on the basis of an official population forecast for Germany is used to isolate the effect of demographic ageing on real per-capita HCE over the coming decades. We find that, while falling mortality rates as such lower HCE, this effect is more than compensated by an increase in remaining life expectancy so that the net effect of ageing on HCE over time is clearly positive.

In this paper, we analyze optimal risk adjustment for direct risk selection (DRS). Integrating insurers' activities for risk selection into a discrete choice model of individuals' health insurance choice shows that DRS has the structure of a contest. For the contest success function (csf) used in most of the contest literature (the Tullock-csf), optimal transfers for a risk adjustment scheme have to be determined by means of a restricted quantile regression, irrespective of whether insurers are primarily engaged in positive DRS (attracting low risks) or negative DRS (repelling high risks). This is at odds with the common practice of determining transfers by means of a least squares regression. However, this common practice can be rationalized for a new csf, but only if positive and negative DRSs are equally important; if they are not, optimal transfers have to be calculated by means of a restricted asymmetric least squares regression. Using data from German and Swiss health insurers, we find considerable differences between the three types of regressions. Optimal transfers therefore critically depend on which csf represents insurers' incentives for DRS and, if it is not the Tullock-csf, whether insurers are primarily engaged in positive or negative DRS. Copyright © 2016 John Wiley & Sons, Ltd.

Wie nachhaltig sind die gesetzliche Krankenund Pfl egeversicherung fi nanziert? Sollten die Ausgaben der gesetzlichen Kranken-und der sozialen Pfl egeversicherung langfristig stark steigen, werden sowohl die jüngere Generation durch höhere Beiträge als auch die Älteren durch mögliche Leistungseinschränkungen belastet. Auf Grundlage einer neueren nichtparametrischen Schätzung wird eine Simulation der zukünftigen Entwicklung der Beitragssätze in den beiden Zweigen der deutschen Sozialversicherung vorgestellt. Abhängig von verschiedenen Annahmen über das künftige Wachstum des BIP pro Arbeitnehmer ergibt sich dabei ein Gesamtsozialversicherungsbeitragssatz bis 2040 von nahe 50 %. Damit ist die Tragfähigkeit des deutschen Sozialversicherungssystems stark gefährdet. Prof. Dr. Friedrich Breyer lehrt Volkswirtschaftslehre an der Universität Konstanz. Er ist Mitglied im Wissenschaftlichen Beirat beim Bundesministerium für Wirtschaft und Energie. Prof. Dr. Normann Lorenz lehrt Volkswirtschaftslehre, insbesondere Sozial-und Verteilungspolitik/Gesundheitsökonomik, an der Universität Trier.

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