At HCHE, over 70 economists and physicians research jointly on solutions on health care problems today and in the future. The interdisciplinary approach provides great opportunities for excellent research in the field of health economics.
In addition, the HCHE uses the comprehensive methodological expertise of its members to create evidence on scientific questions in the field of health economics and to combine scientific requirements and practical implications for politics and decision makers. HCHE focuses on six main fields of research:
Financing Health Care
The research field “Financing Health Care” consists of three main research topics: Optimization of health insurance contracts, financing and composition of social health insurance systems, and demand and perspective of long-term care insurances.
Health care contracts hedge financial risks of illnesses and provide access to expensive treatments. Furthermore, these contracts have an impact on incentives of insured persons to provide for future risks and to make use of medical services efficiently. The HCHE analyzes the impact of different health care contracts and develops models for an optimal design of health care.
There are different ways of financing social health care systems: by individual shares of income, flat rate contributions or tax-based subventions. The HCHE analyzes the impact of these different approaches and develops models and solutions for an optimal design of social insurance systems.
The demand of private nursing and long-term care insurances is relatively low compared to the needs and the probability of long-term care. This observation has an enormous impact in an aging society. The HCHE analyzes reasons and consequences using in particular approaches of behavioral economics.
The HCHE evaluates interventions in health care systems that change the organization of patient’s health care. These interventions are e.g. disease management programs, care management programs, and other innovative approaches on management of patient’s health care. Therefore, we use cost-effectiveness, cost-utility and cost-benefit analyses as well as matching methods and other approaches to analyze risks based on intervention and control groups.
Furthermore, we conduct studies in conjunction with internationally distinguished physicians to assess the economic impact of chronic illnesses and to calculate their financial burden. Depending on the specific aim of the study, its perspective, and the specific sickness, we include direct medical and non-medical costs as well as indirect costs and different approaches to calculate total costs, for example bottom-up or top-down. To generalize the results, we use statistical methods, e.g. Monte Carlo Simulation.
Standard methods of cost-use evaluations presume limits of interpretation in regard to the allocation of benefits of health care programs. On the other hand, empirical surveys show citizen’s attached importance to the distribution of health care benefits. We develop methods including the effects of distribution.
In the research field of health economic evaluations, we use mathematical and statistical methods to assess innovative approaches on health service and therapies to identify superior alternatives and approaches. In this context we use for example decision trees, Markov processes, probabilistic simulations and other methods to support decision analyses.
The increase of post registration trials (phase IV studies) created a new field for routine data. We develop methods to make use of these data in health economic evaluations, for example for health insurances. The adaption or (further) development of methods to adjust risks based on intervention and control group measurements in non-randomized studies – such as propensity score matching or risk scores – as well as concepts of measurement of illness-specific ending points or other important influences such as compliance, routine data approaches, and the application of economic models are an integral part of it.
Outpatient and Inpatient Care
Comparative analyses on performance of health care systems and organizations in the health sector gained in importance to allocate limited health care resources in a meaningful way. We use various methodological approaches – parametric and non-parametric – as well as different performance criteria based on efficiency and/or effectiveness to measure the individual performance of organizations.
Remuneration systems for hospitals and doctors give incentives for the selection of patient’s treatments. On the one hand, prospective systems are advantageous if cost parameters are of interest. On the other hand, these systems might set incentives to decrease treatment quality and treat patients unnecessarily or even refuse to treat patients. We analyze the impact of different remuneration systems and develop models to optimize their design.
Increasing competition between hospitals resulted in a redesign of management procedures in hospitals. Especially instruments of strategic management gain in importance to define a market position and compete successfully with other hospitals. Strategic management of hospitals includes a variety of instruments, e.g. mergers and acquisitions, privatization, network development and specialization. We analyze the impact of strategic management instruments in hospitals based on the three parameters of efficiency, productivity and treatment quality. Thereby, we use state of the art methods of economics to get relevant insight and to provide useful results for hospital managers.
Price regulation of pharmaceutical products is under permanent pressure of static and dynamic market efficiency. Static efficiency demands a price equal to marginal costs of a product. Dynamic efficiency demands a price regulation that includes enough financial incentives for researching companies to invest in research and development of new pharmaceutical products. We analyze the impact of different approaches to regulate prices.
Increasing attempts to limit pharmaceutical product expenditures in health systems has led to a stronger regulation of pharmaceutical markets. We analyze the effects of different policy interventions such as reference pricing, generic substitution, drug budgets and rebate contracts – taking into account the respective policy aims. We focus on changes in patients’ demand of health services, patient-related health outcomes and excess costs.
The trend to contain expenditures and increasing regulations in pharmaceutical changed the competitive environment of the pharmaceutical industry. Depending on their market segment, companies have developed different strategies to cope with these new challenges. We analyze and evaluate the consequences of such strategies by focusing on price and market entrance strategies, and changes in marketing operations.
In this research field, we focus on econometrics of psychological illnesses, health and aging, and economics of obesity.
We evaluate instruments of cost measurement and health impact and analyze cost efficiency of new therapies and treatment programs for psychologically ill patients. For this purpose, we use data of randomized controlled multi-center studies, routine data, as well as model based analyses. Our analyses include illness costs and economic evaluations for depressions, psychological disorders, dementia, eating disorders, anxiety disorders, and addictive disorders. Thus, we cover nearly the whole spectrum of psychological illnesses.
We analyze demands and costs of formal and informal health services as well as effects of private extra payments in representative samples of the elderly part of the society and specially selected elderly patient samples with focus inter alia on multi-morbidity, dementia and osteoporosis. Our data analysis is based on statistical methods for cross-sectional or longitudinal samples. The goal of these analyses is to identify predictors of economic target figures.
Obesity is characterized by high sickness burdens, based on a high degree of prevalence and various associated illnesses such as diabetes mellitus type 2 or hypertension. We quantify these burdens for specific populations by executing cost-of-illness studies. Because of high risks of causing additional illnesses caused, researchers all over the world developed a variety of preventive and therapeutic interventions for affected patients. Based on decision-theoretical models, we analyze the cost efficiency of those interventions in the long run.
Big Data & Digital Health
Increasing digitalization leads to greater availability of bigger and newer data sets, which furthermore opens up new and exciting research questions.
Within the research field ‘Big Data & Digital Health’ methods and analysis of big data sets should be developed and also applied to important questions in health economics.
The research field includes methodical and applied areas:
1) Fundamental research/methods: further development of procedures of machine learning and artificial intelligence; especially to estimate causal effects
2) Applied research:
a) Application of modern methods of machine learning of data sets from the health care sector
b) Analysis of the impact of digitalization on the health care market, i.a. telemedicin