Organisierte Sitzung

The frail, migrants, and the poor: health economics research on crowded institutions and heterogeneity in society

In this session, researchers from the Leibniz University of Hannover provide a snapshot of recent empirical work addressing health economics questions related to vulnerable population groups and connected policies. The presentations touch on diverse issues affecting health care markets and health policy whose empirical analysis requires the employment of a wide array of fit-for-purpose methods. The presented research examines the interplay between competition and the quality of elderly care, patient preferences over scarce health care assets, the determinants of immigrant-native health disparities, and the ability of the poor to cope during the COVID-19 pandemic. In terms of the analytical approaches, a large spectrum of methods is utilized including the workhorse of econometrics, event-study designs, instrumental variable estimation, and randomized experiments.

Vorträge

Provider density and quality of ambulatory long-term care in Germany
Maximilian Lückemann, Center for Health Economics Research Hannover & Institute of Health Economic, Leibniz University Hannover
Einleitung

This paper analyses the effect of provider density on the quality of ambulatory long-term care (LTC) services in Germany, which supported 24 percent of the 4.1 million care-dependent people in 2019 (21 percent received stationary care, and 55 percent informal care). Ambulatory care is politically and individually preferred over stationary care. Low barriers to market entry increased provider density, while there is so far little evidence of the effects of competition in this market. The ambulatory LTC market is characterised by a substantial increase in demand for care and a serious shortage of qualified nurses. We conclude that competition for nurses is a higher priority for providers, which may adversely influence quality. In this study, we challenge the classic theoretical prediction that competition increases quality when prices are regulated. Our findings theoretically and empirically indicate that quality decreases in provider density. To support our findings, we apply an instrumental variable approach and look at different quality measures and market size definitions. In a second step, we show that nursing staff shortage is correlated with higher provider density and lower quality in Germany ambulatory LTC. The dataset includes four waves of publicly available quality data from 14,000 ambulatory care units in Germany, reported between 2011 and 2019. Our findings suggest that a free market entry resulting in higher provider density should be accompanied by respective support for more qualified nursing personnel to circumvent adverse quality effects.

Before asking a patient to use a shared asset decide which you need most
Gianfranco Walsh, Institute of Marketing and Management, Leibniz University Hannover
Einleitung

Healthcare providers around the world are faced with the challenge of managing the costs of healthcare while maintaining the quality of medical services. The more prudent, or shared, use of assets is increasingly seen as a way to reconcile these seemingly competing goals. The sharing economy, which involves activities in relation to sharing underutilized assets (e.g., medical equipment, staff, facilities), typically comprises of three main actors—sharing platforms, asset providers, and users (e.g., consumers, patients). These actors are thought to enjoy decision autonomy, such that they make sharing-related decisions on their own behalf. However, the increasing advocacy of asset sharing in the healthcare sector gives rise to decision situations in which patients have no say in the decision to utilize shared assets whilst being affected by the decision. Interestingly, the pertinent literature is anaemic in regard to studies that examine the effects of what we call ‘provider-driven sharing decisions’. Therefore, drawing on established theories in psychology and preliminary experimental data, we investigate whether sharing a healthcare asset is associated with important patient outcomes, such as the intention to use the healthcare provider again. By focusing on potentially unintended consequences of provider-driven sharing decisions in the healthcare sector, we contribute to research and practice in this field.

Workload and Health: Comparing Migrants and Natives in Germany
Kai Ingwersen, Institute of Economic Policy, Leibniz University Hannover
Einleitung

Workload and its physical and mental burden can have detrimental effects on individual health. As different jobs are associated with specific patterns of health development, occupational selection of socio-economic groups can be attributed to health differences in society. We consider differences in workload and related health status for migrants and native Germans through a detailed characterisation of occupational conditions. Based on the BIBB/BAuA labour force survey for the years 2012 and 2018, our analysis takes a comprehensive set of work-related aspects into account, e.g., work tasks, job requirements, and working conditions. The empirical results show an enhanced perception of workload and related health afflictions among migrants. Working at the performance limit has a particularly strong impact on health, which is countered by a good working atmosphere being beneficial to health. Native Germans are more heavily burdened by high job requirements than migrants, both physically and mentally. However, as job-related factors show similar influence on the health status, the poorer health status of migrants could be attributed to a lower utilization of health services.

Coping During the Covid-19 Pandemic: Evidence from Remittances into Nicaragua
Arndt Reichert, Center for Health Economics Research Hannover & Institute of Health Economic, Leibniz University Hannover
Einleitung

Informal loans and donations from friends or relatives are important ways to cope with health shocks when there is incomplete access to formal credit and insurance markets. When many people experience such shocks locally, the spatial component of the social network is known to gain much importance for risk coping. A particular situation arises in the presence of a global shock that causes everyone in the social network to be affected, including potential remittance senders. This paper shows that despite the economic decline in sending countries the volume and number of remittances to Nicaragua increased substantially during the COVID-19 pandemic. Using administrative data from the largest bank in Nicaragua, we find that this increase comes from new recipients that were not receiving bank remittances before. Complementary household survey data from a sample of recipients suggests that informal channels are rarely used by Nicaraguan migrants, confirming that these new recipients only started to receive remittances once the pandemic started. This suggests that economic contraction in the community of origin weighs strongly, offsetting the economic downturn in the locations of remittance senders.