Attitudes of Germans towards distributive issues in the German health system

Ahlert, Marlies and Pfarr, Christian (2014): Attitudes of Germans towards distributive issues in the German health system.

Abstract

Social health care systems are inevitably confronted with the scarcity of resources and the resulting distributional challenges. Since prioritization implies distributional effects, decisions on respective rules should take citizens’ preferences into account. Thus, knowledge about citizens’ attitudes and preferences regarding different distributional issues implied by the type of financing health care is necessary to judge the public acceptance of a health system. In this study we concentrate on two distributive issues in the German health system: First, we analyse the acceptance of prioritizing decisions concerning the treatment of certain patient groups, in this case patients who all need a heart operation. Here we focus on the fact that a patient is strong smoker or a non-smoker, the criteria of age or the fact that a patient has or does not have young children. Second, we investigate Germans’ opinions towards income dependent health services. The results reveal strong effects of individuals’ attitudes regarding general aspects of the health system on priorities, e.g. that individuals behaving health demanding should not be preferred. In addition, experiences of limited access to health services are found to have a strong influence on citizens’ attitudes, too. Finally, decisions about different prioritization criteria are found to be not independent.

• Item Type: MPRA Paper
• Language: English
• Keywords: health care priority-setting; distributive preferences; quality of health care
• Subjects: D - Microeconomics > D6 - Welfare Economics > D63 - Equity, Justice, Inequality, and Other Normative Criteria and Measurement; D - Microeconomics > D7 - Analysis of Collective Decision-Making > D71 - Social Choice ; Clubs ; Committees ; Associations; I - Health, Education, and Welfare > I1 - Health > I14 - Health and Inequality; I - Health, Education, and Welfare > I1 - Health > I18 - Government Policy ; Regulation ; Public Health

References

Ahlert, M. and Funke, K. (2012), A Mental Model For Decision Making in Allocating Medical Resources, Discussion Paper, Nr. 33-12, Jacobs University, Bremen.

Ahlert, M., Funke, K. and Schwettmann, L. (2013), Thresholds, productivity, and context: an experimental study on determinants of distributive behaviour, in: Social Choice and Welfare 40 [4], pp. 957–984.

Alesina, A. and Angeletos, G.-M. (2005), Fairness and Redistribution, in: The American Economic Review 95 [4], pp. 960–980.

Alesina, A. and Giuliano, P. (2011), Preferences for Redistribution, in: Benhabib, J., Jackson, M. O. und Bisin, A. (Ed.), Handbook of Social Economics, 1A, North Holland, Amsterdam et al., pp. 93–132.

Allianz (2009), Priorisierung im Gesundheitswesen, Eine Umfrage der Allianz AG, München.

Alvarez, B. and Rodríguez-Míguez, E. (2011), Patients' self-interested preferences: empirical evidence from a priority setting experiment, in: Social science & medicine (1982) 72 [8], pp. 1317–1324.

Buhmann, B., Rainwater, L., Schmaus, G., Smeeding and Timothy M. (1988), Equivalence Scales, Well-Being, Inequality, and Poverty: Sensitivity Estimates across Ten Countries using the Luxemburg Income Study (LIS) Database, in: Income and Wealth 34 [2], pp. 115–142.

Corneo, G. and Grüner, H. P. (2002), Individual preferences for political redistribution, in: Journal of Public Economics 83 [1], pp. 83–107.

Diederich, A., Lietz, P., Otten, M., Schnoor, M., Schreier, M., Schröter, J., Winkelhage, J. and Wirsik, N. (2009), Fragebogen zur Erhebung von Präferenzen in der Bevölkerung bezüglich der Verteilung von Gesundheitsleistungen in der GKV, Discussion Paper, Nr. 18-09, Jacobs University, Bremen.

Diederich, A. and Schreier, M. (2010), Einstellungen zu Priorisierungen in der medizinischen Versorgung: Ergebnisse einer repräsentativen Bevölkerungsbefragung, Discussion Paper, Nr. 27-10, Jacobs University, Bremen.

Dolan, P. and Tsuchiya, A. (2005), Health priorities and public preferences: the relative importance of past health experience and future health prospects, in: Journal of health eco-nomics 24 [4], pp. 703–714.

Elster, J. (1995), The Empirical Study of Justice, in: Miller, D. und Walzer, M. (Ed.), Pluralism, Justice, and Equality, Oxford University Press, pp. 81–98.

Fong, C. (2006), Prospective Mobility, Fairness, and the Demand for Redistribution, Working Paper, Carnegie Mellon University, Pittsburgh.

Gouveia, M. (1997), Majority rule and the public provision of a private good, in: Public Choice 93 [3-4], pp. 221–244.

Green, C. (2009), Investigating public preferences on ‘severity of health’ as a relevant condition for setting healthcare priorities, in: Social Science & Medicine 68 [12], pp. 2247–2255.

Greene, W. H. and Hensher, D. A. (2010), Modeling ordered choices, A primer, Cambridge University Press, Cambridge.

Guillaud, E. (2012), Preferences for redistribution: an empirical analysis over 33 countries, in: Journal of Economic Inequality online first doi: 10.1007/s10888-011-9205-0.

Harsanyi, J. C. (1955), Cardinal Welfare, Individualistic Ethics, and Interpersonal Comparisons of Utility, in: Journal of Political Economy 63 [4], pp. 309–321.

Harsanyi, J. C. (1978), Bayesian Decision Theory and Utilitarian Ethics, in: American Economic Review: Papers and Proceedings 68 [2], pp. 223–228.

ISSP Research Group (2013), International Social Survey Programme: Health and Health Care - ISSP 2011 GESIS Data Archive, Cologne . ZA5800 Data file Version 2.0.0, doi: 10.4232/1.11759.

Kifmann, M. (2005), Health insurance in a democracy: Why is it public and why are premiums income related?, in: Public Choice 124 [3/4], pp. 283–308.

Long, J. S. (1997), Regression models for categorical and limited dependent variables, Sage Publ., Thousand Oaks, Calif.

Maddala, G. S. (1983), Limited-dependent and qualitative variables in econometrics, Cam-bridge Univ. Press, Cambridge.

Meltzer, A. H. and Richard, S. F. (1983), Tests of a rational theory of the size of government, in: Public Choice 41 [3], pp. 403–418.

Müller, S. and Groß, D. (2010), Zur Akzeptanz von Leistungsbegrenzungen im Gesundheits-wesen: Strategien, Kriterien und Finanzierungsmodelle unter Berücksichtigung ethischer Aspekte, in: Böcken, J., Braun, B. und Landmann, J. (Ed.), Gesundheitsmonitor 2009. Gesundheitsversorgung und Gestaltungsoptionen aus der Perspektive der Bevölkerung, Verlag Bertelsmann Stiftung, Guetersloh, pp. 258–279.

Raspe, H. and Stumpf, S. (2013), Kriterien und Verfahren zur Priorisierung medizinischer Leistungen: Ergebnisse und methodische Herausforderungen, in: Böcken, J., Braun, B. und Repschläger, U. (Ed.), Gesundheitsmonitor 2013- Bürgerorientierung im Gesundheitswesen, Verlag Bertelsmann Stiftung, pp. 186–210.

Rawls, J. (1971), A Theory of Justice, Oxford University Press, Oxford.

Schomerus, G., Matschinger, H. and Angermeyer, M. C. (2006), Preferences of the public regarding cutbacks in expenditure for patient care: are there indications of discrimina-tion against those with mental disorders?, in: Social psychiatry and psychiatric epidemi-ology 41 [5], pp. 369–377.

Siciliani, L. and Verzulli, R. (2009), Waiting Times and Socioeconomic Status among Elderly Europeans: Evidence from SHARE, in: Health Economics 18 [11], pp. 1295–1306.