Policy implications of heterogeneous demand reactions to changes in cost-sharing: Patient-level evidence from Austria.

Cost-sharing is a prominent tool in many healthcare systems, both for raising revenue and steering patient behaviour. Although the effect of cost-sharing on demand for healthcare services has been heavily studied in the literature, researchers often apply a macro-perspective to these issues, opening the door for policy makers to the fallacy of assuming uniform demand reactions across a spectrum of different forms of treatments and diagnostic procedures. We use a simple classification system to categorize 11 such healthcare services along the dimensions of urgency and price to estimate patients' (anticipatory) demand reactions to a reduction in the co-insurance rate by a sickness fund in the Austrian social health insurance system. We use a two-stage study design combining matching and two-way fixed effects difference-in-differences estimation. Our results highlight how an overall joint estimate of an average increase in healthcare service utilization (0.8%) across all healthcare services can be driven by healthcare services that are deferrable (+1%), comparatively costly (+1.4%) or both (+1.6%) and for which patients also postponed their consumption until after the cost-sharing reduction. In contrast, we do not find a clear demand reaction for inexpensive or urgent services. The detailed analysis of the demand reaction for each individual healthcare service further illustrates their heterogeneity. We show that even comparatively minor changes to the costs borne by patients may already evoke tangible (anticipatory) demand reactions. Our findings help policy makers better understand the implications of heterogeneous demand reactions across healthcare services for using cost-sharing as a policy tool.

Home, sweet home? The impact of working from home on the division of unpaid work during the COVID-19 lockdown.

A lockdown implies a shift from the public to the private sphere, and from market to non-market production, thereby increasing the volume of unpaid work. Already before the pandemic, unpaid work was disproportionately borne by women. This paper studies the effect of working from home for pay (WFH), due to a lockdown, on the change in the division of housework and childcare within couple households. While previous studies on the effect of WFH on the reconciliation of work and family life and the division of labour within the household suffered from selection bias, we are able to identify this effect by drawing upon the shock of the first COVID-19 lockdown in Austria. The corresponding legal measures left little choice over WFH. In any case, WFH is exogenous, conditional on a small set of individual and household characteristics we control for. We employ data from a survey on the gendered aspects of the lockdown. The dataset includes detailed information on time use during the lockdown and on the quality and experience of WFH. Uniquely, this survey data also includes information on the division, and not only magnitude, of unpaid work within households. Austria is an interesting case in this respect as it is characterized by very conservative gender norms. The results reveal that the probability of men taking on a larger share of housework increases if men are WFH alone or together with their female partner. By contrast, the involvement of men in childcare increased only in the event that the female partner was not able to WFH. Overall, the burden of childcare, and particularly homeschooling, was disproportionately borne by women.

Can people afford to pay for health care? New evidence on financial protection in Austria

The incidence of catastrophic health spending is lower in Austria than in many countries in Europe, but higher than in countries such as France, Slovenia, Sweden and the United Kingdom. The main gap in health coverage comes from user charges (co-payments), which are applied to most health services and can be high for some groups of people. Importantly, the type and level of co-payment often vary significantly across social insurance schemes and funds, exacerbating inequality in access to health care. Co-payments for outpatient medicines, however, are uniform across the country, and made more affordable by an income-related cap set at 2% of household income. To improve financial protection in Austria, policy attention should focus on ensuring that low-income households are systematically exempt from all co-payments, and on extending the income-related cap to co-payments for all health services. Some of this could be financed by better use of public resources and redistribution across social insurance schemes through a risk-equalization mechanism.This review is part of a series of country-based studies generating newevidence on financial protection in European health systems.

The effect of stone-wool on rat lungs and on the primary culture of rat alveolar macrophages and type II pneumocytes.

The effect of stone-wool has been studied in both in vivo long term sequential and in vitro methods in male Sprague-Dawley rats. Stone-wool was administered by single intratracheal instillation and the lungs were examined after 1, 3 and 6 months of exposure by morphological methods. UICC crocidolite was applied as a positive control. In addition, the effects of both fibres were examined in primary cultures of alveolar macrophages (AM) and type II pneumocytes (T2) by morphological, biochemical and immunological methods. By the end of 6 months stone-wool induced moderate pulmonary interstitial inflammation and fibrosis without progression, whereas crocidolite induced progressive interstitial inflammation and fibrosis as a function of time. Although stone-wool inhibited phagocytosis, it did not induce serious membrane damage to the cells examined and did not destroy their ultrastructure. It significantly reduced the activity of Cu,Zn/superoxide dismutase (SOD) and alkaline phosphatase (AP) in alveolar macrophages and significantly decreased the activity of AP and gamma-glutamyl transpeptidase (GGT) in type II pneumocytes. Crocidolite, on the other hand, decreased the activity of all enzymes (glutathione peroxidase, GSH-Px; glutathione reductase, GSH-Rd) of glutathione metabolism as well as alkaline phosphatase in alveolar macrophages. It decreased the activity of all enzymes in type II pneumocytes, except for Cu,Zn/SOD. On exposure to stone-wool, the production of inflammatory proteins, macrophage chemoattractant protein-1 (MCP-1) and macrophage inhibitory protein-1alpha (MIP-1alpha) increased in both cultured cells but did not reach the level induced by crocidolite. Our results suggested that stone-wool is less toxic than crocidolite. Whether it is carcinogenic or not, is still an open question.