Three essays in health economics

Many developed countries currently face increasing health care costs, with Switzerland being no exception. Part of this development can be explained by inefficiencies. Therefore, the main objective of this thesis is to elaborate on the causes of such inefficiencies and find possible solutions. This thesis consists of three separate chapters in empirical health economics. For all of these chapters, I use very detailed claims-level data obtained from one of the largest health insurers in Switzerland. In the first chapter of this thesis, I analyse together with Boris Kaiser and Tamara Bischof how practice handovers induced by general practitioner (GP) retirements affect patients’ health care utilization and the associated costs. We conclude that, given access to care is provided, changes in the main GP are not necessarily bad, and thus policy makers should preserve patients’ access to primary care in the case of GP exits. In the second chapter, I analyse together with Christian Schmid and Nicolas Schreiner how a targeted mailing campaign of a large Swiss health insurer, informing their clients about cheaper generic alternatives of brand-name drugs, impacts generic substitution. We conclude that simple but concise information about generic alternatives can significantly increase the probability of generic substitution. In particular, we observe a nearly fourfold increase in the probability to purchase generics following the information letter. This paper thus highlights the potential of a simple and comparably cheap instrument in reducing health care costs. Finally, in the last chapter, I analyse together with Michael Gerfin whether patients with chronic conditions who appear forward-looking and rational in their deductible choice, are also forward-looking with respect to their prescription drug demand. Our results show that patients heavily react to spot prices, which is not what we would expect from rational patients. We conclude that in health insurance, alternatives to deductibles should be considered for treatments such as medications used to treat chronic conditions.

2024

dissertation

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