I11 - Analysis of Health Care MarketsReturn

The changing population dynamics have substantial impact on economy. This paper investigates the effects of demographic change on economic growth. The share of working age population, child dependency ratio, old-age dependency ratio and age dependency ratio are used as demographic variables. The effects of these variables on the gross domestic product per capita growth rate are examined for the OECD countries covering the period 1970-2021. Four different models are estimated by using panel ARDL estimation method. The findings derived from the estimated models point out that the old-age dependency ratio and age dependency ratio have negative effects on economic growth. On the other hand, the share of working age population has a positive effect on economic growth. These results suggest that demographic change causing an increase in the dependency ratio and a decrease in the share of working age population will have adverse impacts on economic performance in the long run.

The paper estimates cost efficiency of 99 general hospitals in the Czech Republic during 2001-2008 using the Stochastic Frontier Analysis. We control for determinants of the inefficiency and found that bigger, not-for-profit and teaching hospitals tend to be less efficient, as well as hospitals in municipalities with a larger share of the elderly. Small hospitals, hospitals in bigger municipalities and hospitals in regions where hospital competition is tense tend to be more efficient.

This paper analyses possible options how to improve the risk adjustment of the health insurance system in the Czech Republic. From the possible options it argues for including pharmaceutical cost groups (PCGs) as additional risk factors since it is an improvement that can be implemented almost instantaneously. On real data from an anonymous sickness fund it confirms that predictive performance of PCGs models is consistently better than the performance of the demographic model that is currently used. The study also describes and examines the Czech health insurance market and implications of proposed changes of policy makers. Based on experience from other countries we point to a problem of risk selection if the changes are not accompanied by a tighter regulation, specifically in the form of improved risk adjustment formula.

Health care reforms in the Czech Republic and in Slovakia are based on the implementation of market-based instruments into the system, namely on privatization and health insurance. Such changes, especially the change of the system of financing of health care from ""socialist"" taxation-based system to ""modern"" insurance-based one, were supported by many arguments, showing expected positive outcomes. However, after more than ten years from starting the change, health care system performance criteria in both countries have not been improved as expected. In our paper we try to examine some potential purposes of such trends, with focus on rhetoric and reality of potential of health insurance to improve the performance of health systems in transitional countries.