Analyzing hidden and indirect factors for rising health expenditure

This thesis comprises four studies on different topics in health economics that all potentially contribute to rising health expenditure: Consequences of demographic change, technological progress, changing trends in awareness for diseases and inefficiencies on health insurance markets. The problems of demographic change are twofold: (i) In an aging society there are less persons in working age that contribute to social pay-as-you-go insurance systems. This decreases the financial base of social insurances while (ii) the share of non-working (older and retired) persons, who do not contribute but benefit from social insurances, increases. Against this background, analyzing consequences of informal caregiving recently gained attention. The first study sheds light on the consequences of the double burden of caregiving and full-time work for caregiver’s health status. It is shown empirically that the double burden deteriorates both, mental and physical health of the caregiver. The second study focuses on indirect consequences of technological progress in medicine which arise from an option value that comes along with technological progress. In a discrete choice experiment it is analyzed whether an option value of future therapies changes risk preferences and leads to an increased demand for marginally effective and risky therapies. It is found that the option value changes risk acceptance and thereby potentially increases demand for such treatments resulting in increasing health expenditure. The third study empirically analyzes spillover effects of insecure job conditions on the health status of spouses. Mental diseases recently gained public attention resulting in an increased number of diagnoses which contributes to rising health expenditure. Therefore, analyzing consequences of a not yet studied facet of unemployment gives insight into mechanisms that deteriorate mental conditions. It is found that perceived fear of job loss worsens the mental health status of spouses. The fourth study uses a laboratory experiment to analyze how consumers choose health insurance. Efficient consumer choice is necessary to encourage competition between insurers and to reach an efficient allocation. It is found that heuristics help individuals to increase individual decision quality. Thereby, the quality measure is based on individual cumulative prospect theory values which are in addition found to explain a substantial amount of observed insurance choices.


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Weßling, J., 2015. Analyzing hidden and indirect factors for rising health expenditure.
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