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What accounts for the regional differences in the utilisation of hospitals in Germany?

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  • Boris Augurzky
  • Thomas Kopetsch
  • Hendrik Schmitz

Abstract

There are huge regional variations in the utilisation of hospital services in Germany. In 2007 and 2008 the states of Hamburg and Baden-Württemberg had on average just under 38 % fewer hospitalisations per capita than Saxony-Anhalt. We use data from the DRG statistics aggregated at the county level in combination with numerous other data sources (e.g. INKAR Database, accounting data from the National Association of Statutory Health Insurance Physicians (KBV), Federal Medical Registry, Germany Hospital Directory, population structure per county) to establish the proportion of the observed regional differences that can be explained at county and state levels. Overall we are able to account for 73 % of the variation at state level in terms of observable factors. By far the most important reason for the regional variation in the utilisation of in-patient services is differences in medical needs. Differences in the supply of medical services and the substitutability of outpatient and inpatient treatment are also relevant, but to a lesser extent. Copyright Springer-Verlag 2013

Suggested Citation

  • Boris Augurzky & Thomas Kopetsch & Hendrik Schmitz, 2013. "What accounts for the regional differences in the utilisation of hospitals in Germany?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(4), pages 615-627, August.
    • Handle: RePEc:spr:eujhec:v:14:y:2013:i:4:p:615-627
    DOI: 10.1007/s10198-012-0407-6
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    Cited by:

    1. Eibich, Peter & Ziebarth, Nicolas, 2014. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," EconStor Open Access Articles and Book Chapters, ZBW - Leibniz Information Centre for Economics, vol. 49, pages 305-320.
    2. Augurzky, Boris & Dördelmann, Sandra & Pilny, Adam, 2016. "Überblick Krankenhausstrukturen Rheinland-Pfalz und Saarland," RWI Projektberichte, RWI - Leibniz-Institut für Wirtschaftsforschung, number 149878, March.
    3. Herwartz, Helmut & Schley, Katharina, 2018. "Improving health care service provision by adapting to regional diversity: An efficiency analysis for the case of Germany," Health Policy, Elsevier, vol. 122(3), pages 293-300.
    4. Tugba Büyükdurmus & Thomas Kopetsch & Hendrik Schmitz & Harald Tauchmann, 2017. "On the interdependence of ambulatory and hospital care in the German health system," Health Economics Review, Springer, vol. 7(1), pages 1-19, December.
    5. Natalie Baier & Lisa-Marie Sax & Leonie Sundmacher, 2019. "Trends and regional variation in rates of orthopaedic surgery in Germany: the impact of competition," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 163-174, February.
    6. Wende, Danny & Kopetsch, Thomas & Richter, Wolfram F., 2020. "Planning health care capacities with a gravity equation," Ruhr Economic Papers 888, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    7. Thomas Kopetsch & Hendrik Schmitz, 2014. "Regional Variation In The Utilisation Of Ambulatory Services In Germany," Health Economics, John Wiley & Sons, Ltd., vol. 23(12), pages 1481-1492, December.
    8. Rouven Edgar Haschka & Katharina Schley & Helmut Herwartz, 2020. "Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(1), pages 55-71, February.
    9. Augurzky, Boris & Beivers, Andreas & Straub, Niels & Veltkamp, Caroline, 2014. "Erarbeitung von Umsetzungsvorschlägen der Positionen der Ersatzkassen zur Krankenhausplanung: Vorläufiger Endbericht zum Forschungsvorhaben des Verbandes der Ersatzkassen e. V. (vdek)," RWI Projektberichte, RWI - Leibniz-Institut für Wirtschaftsforschung, number 111481, March.
    10. Peter Eibich & Nicolas R. Ziebarth, 2013. "Examining the Structure of Spatial Health Effects in Germany Using Hierarchical Bayes Models," SOEPpapers on Multidisciplinary Panel Data Research 620, DIW Berlin, The German Socio-Economic Panel (SOEP).
    11. Leonie Sundmacher & Thomas Kopetsch, 2015. "The impact of office-based care on hospitalizations for ambulatory care sensitive conditions," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 16(4), pages 365-375, May.

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    More about this item

    Keywords

    Hospital utilisation; Regional differences; Substitutability; I11; I18;
    All these keywords.

    JEL classification:

    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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