Andreas Werblow

Do the Age Profiles of Health Care Expenditure Really Steepen Over Time? - New Evidence from Swiss Cantons

The red herring hypothesis contends that the high health care expenditure in old age is caused by proximity to death rather than calendar age. Dissenters point to longitudinal data and claim that health care expenditure age profiles tend to steepen over time. The present paper tests the steepening claim for Swiss health insurance, covering the time period 1997 to 2006 and 25 cantons. It analyzes the cantonal health care expenditure profile of men and women, taking into account differences in the mortality rates. The study covers seven components of health care, including long-term care. By and large, no evidence is found for relevant steepening effects of age profiles for either total, or the components, of health care expenditure.

A Priori Risk and Optimal Test Accuracy in Prenatal Diagnostics

The prevalence of fetal chromosome anomalies rises exponentially with the age of the pregnant woman. The risk of fetal anomalies can be specified using biochemical screening tests such as the triple test. This test substantially reduces the number of amniocenteses and proportionally the number of procedure-related miscarriages. However, disadvantages of the triple test include the utility loss of pregnant women who, following a false-negative test result, do not undergo amniocentesis and bear a disabled child as well as the intangible cost of a false-positive triple test. This paper employs a decision-analytic model to reveal the evaluation of this tradeoff, which is implicitly fixed by policy recommendations for a direct amniocentesis at maternal age of 35. It then determines the optimal level of cutoff risk for the triple test, and derives comparative static results: the optimal test accuracy decreases with increasing a-priori risk and increases with a rise in the miscarriage risk and in the womans preference for detecting an affected fetus as compared to avoiding a miscar-riage of an unaffected fetus. These results are in contrast to current clinical practice, where the cutoff of the triple test usually remains fixed.

Gesundheitsökonomie: Nachfrage nach Gesundheitsleistungen

Die Gesundheitsokonomie analysiert die wirtschaftlichen Aspekte des Gesundheitswesens und verwendet dabei Konzepte der okonomischen Theorie. Im Allgemeinen befasst sie sich mit der Optimierung der Verteilung knapper Guter zur Befriedigung von Bedurfnissen (vgl. Schulenburg/Greiner 2000). Dabei steht die Erhaltung von Gesundheit im Vordergrund. Gesundheit wird haufig als „unendlich wertvoll“ bezeichnet. Jeder Konsum verliert an Wertschatzung, wenn er die Gesundheit des Konsumenten beschadigt. Allerdings verhalten sich Menschen nicht immer konform zu dieser Pramisse.

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

SummaryThis 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.

Constraints of Cross-Border Medical Care - An Analysis in a Heckscher-Ohlin Framework

A gain of efficiency is postulated by the neoclassical theory of trade. Free trade is necessary to realize a full or partial specialization in the production of goods. The paper analyzes specialization of medical services in the framework of cross-border medical care. As theoretical framework the Heckscher-Ohlin model is applied. As generally postulated by the model an extension of medical provision becomes possible, however, constrained by transport costs, partial mobility of patients and fixed provider prices. As a consequence, relocation and specialization is constrained. This means the necessity of local provision of medical care in a minimum amount. The real potential of a realization of gains from trade in medical care must be put into question.