Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons

Crivelli, Luca; Filippini, Massimo; Mosca, Ilaria

doi:10.1002/hec.1072

Cited by 111 publications

(102 citation statements)

References 13 publications

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“…For example, international level approaches include [13,17] showing that both income levels and the structure of health care financing are relevant health expenditure variables. Similar results have also been discussed at a regional health care expenditure level [8,20,28,30,22,7,11].…”

Section: Review Of the Literaturesupporting

confidence: 81%

“…In total, we thus have 5 · 17 = 85 observations on integrated care. 8 For data on disease management programs, we used statistics reported by the federal social insurance authority for the period 2005 to 2011, and hence have 7 · 17 = 119 observations. We focus on pharmaceutical expenditure (PE) as the dependent variable.…”

Section: Data Base and Variable Definitionsmentioning

confidence: 99%

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Cost Containment and Managed Care: Evidence from German Macro Data

2013

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThe major German health care reforms undertaken since the late 1990s resulted in the adoption of selective contracting mechanisms in a formerly sectorally separated health care system. These reforms marked the launch of managed care in Germany that is expected to yield both a higher quality of care and cost containment. We investigate if managed care had an influence on the structure of health care expenditure in Germany during the start-up phase of managed care from 2004 to 2008. We focus on pharmaceutical spending by statutory sickness funds (i.e. German lawenforced health insurance). We followed a macroeconomic evaluation approach based on a regional panel data set in contrast to previous research and were thus able to control for a comprehensive set of regional and demographic variables. We discuss alternative model specifications and include a range of sensitivity analyses. Our results suggest that in contrast to public perception the share of managed care contracts has a positive impact on pharmaceutical spending.

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Section: Review Of the Literaturesupporting

confidence: 81%

Section: Data Base and Variable Definitionsmentioning

confidence: 99%

Cost Containment and Managed Care: Evidence from German Macro Data

2013

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“…Our instrument is very strong with a first stage F-Test on the excluded instrument of 222. 11 The 2nd stage results reveal a substantially increased point estimate for the effect of location size. This increase goes in the expected direction as the reverse causality running from taxes to location size would have predicted a negative relationship between local taxes and location size.…”

Section: Urban Area Level Resultsmentioning

confidence: 92%

“…As described in section 4.6, our two instruments are land reserves in the centre municipality in 1985 (LandReserveCentre) and 2005 employment predicted from the 1985 sector composition (P redEmplArea). Our 11 We use robust tests throughout as we have no reason to assume that our error term is homoscedastic. instruments are individually and jointly highly significant in the first stage (see Table A1 in the appendix).…”

Section: Urban Area Level Resultsmentioning

confidence: 99%

The effect of agglomeration size on local taxes

Luthi

Schmidheiny

2013

Journal of Economic Geography

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. The Effect of Agglomeration Size on Local Taxes Abstract Standard tax competition models predict a 'race-to-the-bottom' of corporate tax rates when firms are mobile. Recent theoretical literature has qualified this view by offering a theoretical explanation why this extreme prediction need not occur: central regions with large clusters of economic activity are able to set positive tax rates without fearing to lose firms to peripheral regions as the firms would forego 'rents' from agglomeration economies. In this paper, we study whether local policy makers effectively tax such agglomeration rents. We test this with panel data from Swiss municipalities between 1985 and 2005. We find that large urban areas set indeed higher tax rates than small ones. This is consistent with the theoretical prediction. Within urban areas, however, municipal tax rates are unrelated to the size of economic activity in and around municipalities while they are positively related to the size of the political jurisdiction. We see this result as evidence that the standard tax competition model for asymmetric jurisdictions is at work in the competition of municipalities within an urban area. Both results are robust to controlling for reverse causality by using instrumental variables. Controlling for fixed effects in a 20 year panel is non-informative and neither supports nor contradicts these findings. As a robustness check we introduce an new measure of cluster intensity which considers the varying intensities in agglomeration economies across sectors. Terms of use: Documents inJEL-Code: R300, H320.

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“…The sickness funds' premiums are allowed to differ between regions, and subsidies to the stationary health care sector as well as health premium subsidies to low-income individuals are governed by the local authorities, which are endowed with their own tax revenues. The pertinent federalism in health care has led to different regional levels of health care provision and corresponding expenditures (see Crivelli et al, 2006). For instance, the West of Switzerland spends almost twice as much on health care as the East.…”

Section: Resultsmentioning

confidence: 99%

The Marginal Cost of Saving a Life in Health Care: Age, Gender and Regional Differences in Switzerland

Felder

Werblow

2009

Swiss J Economics Statistics

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Summary This paper estimates the marginal cost of saving a life using age- and gender-specific health care expenditures and mortality rates of the 26 Swiss cantons for the period 1997 to 2006. It shows almost triple the marginal cost of saving a life for women as compared to men, reflecting a lower marginal elasticity of medical inputs, a lower mortality rate and higher spending on health care for women. Medical technology does not differ across cantons while the marginal cost of saving a life does. Wealthy cantons spend more on saving a life at the margin and show a smaller gender gap in longevity.

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Federalism and regional health care expenditures: an empirical analysis for the Swiss cantons

Cited by 111 publications

References 13 publications

Cost Containment and Managed Care: Evidence from German Macro Data

Cost Containment and Managed Care: Evidence from German Macro Data

The effect of agglomeration size on local taxes

The Marginal Cost of Saving a Life in Health Care: Age, Gender and Regional Differences in Switzerland

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