The Market for Healthcare Services: An Empirical Analysis

医疗保健市场是德国增长最强劲的市场之一。1999至2009年间，需要长期保健的人数增加了16%，固定护理设施的数量增加了约31%。2009年，卫生保健服务占整个卫生市场的份额达到11%。尽管卫生保健的社会和经济作用越来越大，但现有的关于卫生保健市场功能的知识是有限的。在此背景下，该研究项目旨在为现有的有关保健服务需求和供应的经验证据作出贡献。该项目的成果可能有助于改善对需要长期保健的人的服务，并揭示护理市场潜在的低效。因此，该项目在卫生和社会政策方面也是相关的。对拟议研究项目的科学分析在三个工作包内进行。第一套方案的重点是医疗服务的需求。以下问题是人们感兴趣的中心：哪些因素决定了对某些卫生保健服务的需求？价格、关于服务质量的现有信息以及到护理设施的距离在多大程度上影响对某一固定护理设施的需求？这一一揽子工作的结果使我们能够评估未来对流动和固定护理的需求，以及区域对固定护理设施的需求。第二个工作方案侧重于护理市场的供应方，侧重于流动和固定护理服务质量方面的潜在差异。这一一揽子计划的目的是提供关于护理部门在例如不适当的药物方面的潜在低效的量化证据。最后，第三个工作包调查了固定护理服务市场的竞争情况。由于这个市场上的价格是有管制的，所以将通过服务质量来分析这个市场上是否以及在多大程度上发生了竞争。此外，这套方案将侧重于医疗服务价格和质量之间的关系。拟议研究项目的实证分析将主要使用广泛的小组数据集，这些数据集是从Techniker Krankenkasse的720多万人的过程数据中抽样的。该项目将进一步使用德国统计局的护理统计数据以及由德国统计研究所(MDK)提供的质量数据。该项目将专注于能够确定因果关系的经验方法。

The market for health care is one of the strongest growing markets in Germany. Between 1999 and 2009 the number of persons in need for long-term health care has risen by 16% and the number of stationary nursing facilities by about 31%. In 2009 the share of health care services reached 11% of the entire health market. Despite the increasing social and economic role of health care, the existing knowledge about the functionality of the health care market is limited. Against this background the research project aims to contribute to the existing empirical evidence concerning the demand for and supply of health care services. The results of the project may help improve the services for persons in need of long-term health care and to uncover potential inefficiencies in the nursing market. Hence, the project is also relevant with regard to health and social policy. The scientific analysis of the proposed research project occurs within three working packages. The first package focuses on the demand for health care services. The following questions are at the centre of interest: Which factors determine the demand for certain health care services? To what extent does the price, the available information about the quality of the services as well as the distance to the nursing facility affect the demand for a certain stationary nursing facility? The results of this working package permit an evaluation of the future demand of ambulant and stationary nursing as well as the regional need for stationary nursing facilities. The second working package focuses on the supply side of the nursing market, concentrating on potential differences in the quality of ambulant and stationary nursing services. The aim of this package is to deliver quantitative evidence on potential inefficiencies of the nursing sector in terms of, e.g., inappropriate medication. Finally, the third working package investigates the competitive situation in the market for stationary nursing services. Because the price on this market is regulated, it will be analyzed whether and to what extend competition on this market occurs via service quality. Furthermore, this package will focus on the relationship between the price and the quality of the health care services. The empirical analysis of the proposed research project will predominantly use an extensive panel data set, sampled out of the process data of more than 7.2 million persons of the Techniker Krankenkasse. The project will further use the nursing statistic of the German statistical office as well as quality data provided by the Medizinischer Dienst der Krankenversicherung (MDK). The project will concentrate on empirical methods that allow the identification of causal relationships.