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年至2009年期间，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，保健服务的份额达到整个保健市场的11%。尽管医疗保健的社会和经济作用越来越大，但有关医疗保健市场功能的现有知识是有限的。在此背景下，该研究项目的目的是促进现有的经验证据有关的需求和医疗保健服务的供应。该项目的结果可能有助于改善为需要长期保健的人提供的服务，并发现护理市场潜在的低效率。因此，该项目也与卫生和社会政策有关。对拟议研究项目的科学分析在三个工作包中进行。第一套方案集中于对保健服务的需求。以下问题是关注的中心：哪些因素决定了对某些保健服务的需求？在何种程度上的价格，有关服务质量的可用信息，以及距离护理设施影响的需求，一定的固定护理设施？这一工作包的结果允许流动和固定护理的未来需求，以及固定护理设施的区域需求进行评估。第二个工作包侧重于护理市场的供应方，集中于流动和固定护理服务质量的潜在差异。这套方案的目的是提供量化证据，说明护理部门在以下方面的潜在效率低下：不适当的药物。最后，第三个工作包调查了固定护理服务市场的竞争状况。由于该市场上的价格是受管制的，因此将分析该市场上是否通过服务质量进行竞争以及在何种程度上进行竞争。此外，这套方案将侧重于医疗服务价格与质量之间的关系。拟议研究项目的实证分析将主要使用广泛的面板数据集，从Techniker Krankenkasse的720多万人的过程数据中抽样。该项目将进一步使用德国统计局的护理统计数据以及医疗保健机构提供的质量数据。该项目将侧重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.