Open Access

Martina Grunow

• In this dissertation three different topics in health economics are analyzed and discussed. These topics either contribute to the basic research or provide applications of central topics of health economics as depicted in Chapter 1. The core of each empirical study provided in this dissertation is a positive analysis to improve the understanding within the respective subfield. In addition, normative discussions of the results and insights derived from the positive analyses are provided for each topic in order to contribute to the discussion of current and challenging issues that health care systems are actually facing today. Chapter 2 of this dissertation provides a theory-based empirical analysis of the effect of unemployment on mental well-being. The specification of our econometric model is based on theoretical models for reference-dependence utility with endogenous reference points. We hypothesize that the negative effect of unemployment on mental well-being is more severe in theIn this dissertation three different topics in health economics are analyzed and discussed. These topics either contribute to the basic research or provide applications of central topics of health economics as depicted in Chapter 1. The core of each empirical study provided in this dissertation is a positive analysis to improve the understanding within the respective subfield. In addition, normative discussions of the results and insights derived from the positive analyses are provided for each topic in order to contribute to the discussion of current and challenging issues that health care systems are actually facing today. Chapter 2 of this dissertation provides a theory-based empirical analysis of the effect of unemployment on mental well-being. The specification of our econometric model is based on theoretical models for reference-dependence utility with endogenous reference points. We hypothesize that the negative effect of unemployment on mental well-being is more severe in the case of unexpected unemployment. As the central outcome, the econometric analysis yields empirical evidence for a reference-dependent relationship between unemployment and mental well-being. The results suggest that becoming unemployed unexpectedly hurts individuals harder than when unemployment was expected. Chapter 3 of this dissertation provides an analysis of risk selection problems in the German health insurance market with dual sources of financing. Several institutional differences between public and private health insurance provide strong incentives for risk selection by the insurance providers and for an elaborate selection of an insurer on part of the insured. The empirical analysis in Chapter 3 clearly shows that the incentives due to institutional differences between the public and the private health insurance systems in Germany do indeed lead to observable risk selection between both systems. Chapter 4 of this dissertation analyzes the effectiveness of the organized breast cancer screening in Germany. While mammography is accepted as a proven diagnosis tool for breast cancer, the discussion in the literature of the effectiveness of organized screening programs has attracted some controversy. For Germany, where an organized mammography screening program has gradually been implemented nationwide since 2001, no analysis of the effectiveness of this program has been attempted so far. In Chapter 4 of this dissertation an empirical analysis of the effectiveness of the German mammography screening program is provided and discussed. We exploit the step-by-step implementation of the program at the regional level to analyze the effectiveness of the organized screening program in the setting of a natural experiment. Our results suggest no effect of the organized screening program on breast cancer mortality.…