title: Unintended effects of a cost-containment policy: results of a natural experiment in Germany.
abstract: In this paper empirical evidence for substitution processes caused by the budget for drugs prescribed by office-based physicians is provided. Due to substitution processes in a natural experiment the number of referrals and hospital admissions increased significantly after the introduction of a drug budget in Germany. This leads to additional direct and indirect cost for the health care system.
authors.affiliation: University of Hanover, Institut für Versicherungsbetriebslehre, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Schöffski
authors.forename: J M
authors.initials: JM
authors.lastname: Graf von der Schulenburg
mesh_terms: D002017:Budgets / Q000331:legislation & jurisprudence*; D003361:Cost Allocation / Q000706:statistics & numerical data; D003363:Cost Control / Q000331:legislation & jurisprudence / Q000379:methods; D003657:Decision Making; D004363:Drug Utilization / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D005858:Germany; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000639:trends; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000331:legislation & jurisprudence; D007356:Insurance, Pharmaceutical Services / Q000331:legislation & jurisprudence*; D008137:Longitudinal Studies; D009313:National Health Programs / Q000191:economics* / Q000331:legislation & jurisprudence; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D011320:Primary Health Care / Q000191:economics* / Q000331:legislation & jurisprudence / Q000639:trends; D012017:Referral and Consultation / Q000191:economics / Q000639:trends; D012189:Retrospective Studies