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Guhl D.,University of Hamburg | Stargardt T.,University of Hamburg | Schneider U.,WINEG Scientific Institute of TK for Benefit and Efficiency in Health Care | Fischer K.E.,University of Hamburg
Health Policy | Year: 2016

Objective: We aim to investigate pharmacies' dispensing behaviour under the existing dispensing regulations in Germany. Methods: Using administrative data, we performed a cross-sectional retrospective study to analyse whether the competitive environment and pharmacy characteristics, i.e., organisation, lead to dispensing choices aimed at by third-party payers. We specified generalised linear models with the share of imported pharmaceuticals, generic share, and share of preferred brands as dependent variables. Results: The final dataset contained 49,260,902 prescriptions from 16,797 pharmacies. The average share of imported pharmaceuticals across the pharmacies was 18.4% (standard deviation (SD) 8.8), the average generic share was 92.8% (SD 2.1), and compliance with preferred brands was 81.3% (SD 5.9). Pharmacies with little competition used fewer imported pharmaceuticals (p < 0.001), generics (p < 0.001) and preferred brands (p < 0.001); less organised pharmacies yielded similar results. The difference in outcomes between pharmacies in the first and 4th quartiles of the pharmacy organisation variable is 17.4% vs. 17.0% for share of imported pharmaceuticals, 92.8% vs. 92.7% for generic share and 81.9% vs. 81.1% for compliance with preferred brands. Conclusion: We show that pharmacies' dispensing choices meet the aims of payers at high levels. However, dispensing behaviour varies between pharmacies. Increasing competition among pharmacies and targeting pharmacies with high shares of bill auditing seem viable options to improving dispensing behaviour as defined by payers. © 2016 Elsevier Ireland Ltd. Source


Stroka M.A.,Westphalian Institute for Economic Research | Stroka M.A.,Ruhr University Bochum | Stroka M.A.,WINEG Scientific Institute of TK for Benefit and Efficiency in Health Care
European Journal of Health Economics | Year: 2016

A widely discussed shortcoming of long-term care in nursing homes for the elderly is the inappropriate or suboptimal drug utilization, particularly of psychotropic drugs. Using administrative data from the largest sickness fund in Germany, this study was designed to estimate the effect of institutionalization on the drug intake of the frail elderly. Difference-in-differences propensity score matching techniques were used to compare drug prescriptions for the frail elderly who entered a nursing home with those who remained in the outpatient care system; findings suggest that nursing home residents receive more doses of antipsychotics, antidepressants, and analgesics. The potential overprescription correlates with estimated drug costs of about €87 million per year. © 2015, Springer-Verlag Berlin Heidelberg. Source


Schneider U.,WINEG Scientific Institute of TK for Benefit and Efficiency in Health Care | Linder R.,WINEG Scientific Institute of TK for Benefit and Efficiency in Health Care | Verheyen F.,WINEG Scientific Institute of TK for Benefit and Efficiency in Health Care
European Journal of Health Economics | Year: 2016

The implementation of a graded return-to-work (RTW) program to reintegrate the long-term sick started in Germany in 1971 and has been manifested in the Social Code Book V since 1989. Based on a return plan by the physician and the insured, participants increase their working hours slowly over a specified period of time. As participants are still classified as incapable of working they still receive sick leave benefits. Using claims data from the Techniker Krankenkasse, the largest German sickness fund, the study aims at identifying participants and analyzing the full return-to-work and the impact of the RTW program. Thereby, we account for socio-economic factors, insurance-based characteristics, and medical and health-related information. We consider a possible selection bias by using individual weights to analyze determinants of length of the sickness absence by applying models for survival analysis (Cox proportional hazard model). As a main result — depending on the central assumption of unconfoundedness — sickness absence is positively related to participation in the RTW program for those with sickness absence longer than 120 days. For mental disorders, our results indicate an even stronger effect. The study results emphasize the need further promotion of this instrument among those insured, physicians and employers, as occupational health management is one key for a successful return-to-work. © 2015, Springer-Verlag Berlin Heidelberg. Source

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