This paper presents the results of a randomized study of a home visiting programme implemented in Germany for low-income, first-time mothers. A major goal of the programme is to improve the participants’ economic self-sufficiency and family planning. I use administrative data from the German social security system and detailed telephone surveys to examine the effects of the intervention on maternal employment, welfare benefits, and household composition. The study reveals that the intervention unintentionally decreased maternal employment and increased subsequent births. These results contradict those of previous studies from the United States, where home visiting programmes successfully increased employment and decreased fertility. Low employment incentives and generous welfare state arrangements for disadvantaged mothers with young children in Germany may explain the different results.
From dusk till dawn - are nights a dangerous time for hospital admission?
This paper addresses the question whether patients have a higher risk of death if they are admitted to a hospital during the night rather than during the day. Since hospital resources and stuffing are reduced at nights, both numerically and with regard to available expertise on site, there is a theoretical channel, explaining why night admissions might be more dangerous. However, since patients admitted during the night are special in terms of urgency and admission time, simple comparisons of the groups may be misleading. To facilitate comparison, the empirical analysis compares patients who suffer from specific diseases considered as emergency conditions, i.e. upper gastrointestinal bleeding, or acute myocardial infarction and is based on regression adjusted propensity score matching as identification strategy. A full sample of all inpatients in Germany for the years 2005 to 2007 is used. Additionally, I execute two sensitivity analyses to determine how unobserved heterogeneity influences the results. Although the results show that patients admitted during the night have a higher risk of death, sensitivity analyses suggest, that this result is likely to be driven by unobserved patient heterogeneity.
Evaluation studies on gatekeeping in primary care exist for a variety of countries but provide mixed evidence on utilization and quality of care as well as costs. Our study evaluates the German gatekeeping program, based on claims data of a major statutory health insurance company. The panel structure of the data allows controlling for patients’ characteristics in the year before opting (or not opting) for a GP contract. In contrast to previous studies we are able to draw on multiple identification strategies. We exploit variation in the regional provision of gatekeeping in an instrumental variable (IV) framework. We also analyze GP fixed effects based on the observation of patients opting for one of two different contracts within the same GP office. We find that the gatekeeping contract yields a somewhat higher coordination of care, improved quality (regarding prevention and avoidance of hospitalization) but also higher ambulatory costs. The effects are largely robust between our identification strategies.