Economic Journal Articles

S. Reif, S. Schubert and A. Wambach (2025) “Setting incentives right with long-term risk adjustment” In European Journal of Health Economics, Editorial.

Current risk adjustment schemes in social health insurance provide little incentives for health insurers to engage in investments in enrollee health and efficiency enhancing innovations. We propose a long-term risk adjustment scheme, which still prevents risk selection, but makes it financially attractive for insurers to care about long-term health of their enrollees and increases efficiency.

F. Valder, S. Reif and H. Tauchmann (2025) “Diagnosis Related Payment for Inpatient Mental Health Care: Hospital Selection and Effects on Length of Stay” In Health Economics.

We study a policy introducing diagnosis related payment for inpatient mental health care in Germany with rates decreasing over length of stay. Using data on all hospital cases, we first examine which hospitals voluntarily opt into the new scheme. We show that specialized hospitals that treat more complicated cases and are reimbursed more highly under the new scheme select into it. Second, we study the effect of diagnosis related payment on length of stay. We find that diagnosis related payment is associated with large reductions in length of stay but has no effect on mortality, post-acute care, or the ambulatory sector. We argue that the reductions in length of stay are driven by the fact that diagnoses related reimbursement is higher for more complex cases and by payment decreasing over length of stay. This novel evidence contributes to a scarce literature on the role of payment systems for inpatient mental health care and provides important insights for policymakers.

S. Reif and S. Schubert (2024) “Hospital capacity reporting in Germany during Covid-19” In Journal of Economic Behavior & Organization, Vol. 228: 106730.

During the COVID-19 pandemic, hospitals faced a unique predicament. Hospital care was urgently needed and society took efforts to prevent overwhelming hospitals. However, hospitals in case-based reimbursement schemes faced financial problems because of canceled elective care visits and government regulations to keep capacity free for Covid-19 patients. Therefore, emergency financing measures were implemented in many countries. We analyze how hospitals in Germany responded to a scheme that provided financial support if the intensive care unit (ICU) occupancy rate in a county exceeded 75%. The scheme distributed over seven billion euros to hospitals and was notable because financial support depended on a measure (ICU occupancy rate) that hospitals could directly influence. To analyze hospitals’ reactions to this scheme, we employ event study analyses comparing ICU capacity before and after regions became eligible. We find no evidence of strategic reporting at an economically meaningful and hence empirically detectable scale.

C. Bünnings, L. Hafner, S. Reif and H. Tauchmann (2021) “In Sickness and in Health? Health Shocks and Relationship Breakdown: Empirical Evidence from Germany” In Journal of Economic Behavior & Organization, Vol. 190: pp. 164-190.

From an economic perspective, marriage and long-term partnership can be seen as a risk-pooling device. This informal insurance contract is, however, not fully enforceable. Each partner is free to leave when his or her support is needed in case of an adverse life event. An adverse health shock is a prominent example for such events. Since relationship breakdown itself is an extremely stressful experience, partnership may backfire as informal insurance against health risks, if health shocks increase the likelihood of relationship breakdown. We address this question empirically, using survey data from Germany. Results from various matching estimators indicate that adverse shocks to mental health substantially increase the probability of a couple splitting up over the following two years. In contrast, there is little effect of a sharp decrease in physical health on relationship stability. If at all, physical health shocks that hit both partners simultaneously stabilize a relationship.

Marcus, J., S. Reif, A. Wuppermann and A. Rouche (2020) “Increased Instruction Time and Stress-Related Health Problems among School Children” In Journal of Health Economics, Vol. 70, 102256.

While several studies suggest that stress-related mental health problems among school children are related to specific elements of schooling, empirical evidence on this causal relationship is scarce. We examine a German schooling reform that increased weekly instruction time and study its effects on stress-related outpatient diagnoses from the universe of health claims data of the German Social Health Insurance. Exploiting the differential timing in the reform implementation across states, we show that the reform slightly increased stress-related health problems among school children. While increasing instruction time might increase student performance, it might have adverse effects in terms of additional stress.

Reif, S., S. Wichert and A. Wuppermann (2018) “Is it good to be too light? Birth weight thresholds in hospital reimbursement systems” In Journal of Health Economics, Vol. 59: pp. 1-25.

Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005–2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals' financial incentives with respect to birth weight do not directly impact the care that newborns receive.

Medical and Interdisciplinary Journal Articles

Gorenflo, J., B. Reichert, German Burn Registry, S. Reif, I.-F. Megas and M. Billner (2024) “The prognostic relevance of full-thickness burns on ABSI” In Burns, Vol. 50(9): 107197.

Brönneke, J. B., A. Herr, S. Reif and A. Stern (2023) “Dynamic HTA for Digital Health Solutions: Opportunities and Challenges for Patient-Centered Evaluation” In International Journal of Technology Assessment in Health, Vol. 39(1): pp. e72.

Reif, S., S. Schubert, J. Stiefel, F. Husri, T. Fischlein, M. Pauschinger and J. Klucken (2022) “Supporting patients with heart failure with digital therapeutics—A pilot study in Germany” In Digital Health, Vol. 8: pp. 1-8.

Stern, A., J. Broenneke, J. Debatin, J. Hagen, H. Matthies, S. Patel, I. Clay, B. Eskofier, A. Herr, K. Hoeller, A. Jaksa, D. Kramer, M. Kyhlstedt, K. Lofgren, N. Mahendraratnam, H. Muehlan, S. Reif, L. Riedemann and J. Goldsack (2022) “Advancing digital health applications: Priorities for innovation in real-world evidence generation” In The Lancet Digital Health, Vol. 4: pp. e200-06.

Billner, M., S. Reif, German Burn Registry and B. Reichert (2022) “The effect of self-inflicted burns on ABSI score prediction power: A four-year prospective multicenter study of the German Burn Registry” In Burns, Vol. 48(7): pp. 1710-1718.

Reif, S., L. Hafner and M. Seebauer (2020) “Physician Behavior under Prospective Payment Schemes - Evidence from Artefactual Field and Lab Experiments” In International Journal of Environmental Research and Public Health, Vol. 17(15), 5540.

Billner, Moritz, Anne Wirthmann, Simon Reif and Ulrich M. Rieger (2016) “Poly Implant Prothèse and Rofil Substandard Breast Implant Explantations from a Large German Single Centre from 2011 to 2014: A Comparative Study” In Aesthetic Plastic Surgery, Vol. 40, No. 4: pp. 507–513.

Reports and Articles in German

S. Reif, T. Bolz and Y. Karamik (2024) “Produktivitätsparadoxon der Digitalisierung im Krankenhaus – auf der Suche nach effizienzsteigernden Innovationen”, Wirtschaftsdienst, Vol. 104(9): pp. 599-602.

S. Reif, S. Schubert and A. Wambach (2024) “Reformvorschlag für einen Nachhaltigen Risikostrukturausgleich”. ZEW Policy Brief Nr. 24-03.

S. Reif, J. Köhler and S. Schubert (2023) “Behandlungsgespräche in der Arztpraxis – Ein Europäischer Vergleich”. ZEW Projektbericht, Mannheim.

Fischer, M., H. Jürges, S. Mangelsdorf, S. Reif, H. Ullrich and A. Wuppermann (2023) “Gesundheitsdaten: Von Nachbarländern lernen”, Wirtschaftsdienst, Vol. 103(11): pp. 737-740.

Andres, R., J. Axenbeck, I. Bertschek, P. Breithaupt, R. Janßen, E. Kollmann, T. Niebel, S. Reif and M. Seifried (2021), “Metastudie – Chancen und Herausforderungen der Digitalisierung in Baden-Württemberg”. Ministerium für Inneres, Digitalisierung und Migration Baden-Württemberg, Mannheim.

Reif, S. and S. Schubert (2021) “Vorsorgelücke während der Coronavirus-Pandemie – Vorsorgeuntersuchungen in der Krise”. ZEW-Kurzexpertise Nr. 21-02, Mannheim.

Augurzky, B., S. Decker, A. Mensen and S. Reif (2020) “BARMER Krankenhausreport 2020 - Volume-Outcome im Krankenhaus”. Schriften zur Gesundheitssystemanalyse, Band 25.

Augurzky, B., T. Korfhage, S. Reif and D. Reifferscheid (2019) “Reformvorschläge für die Krankenhausabrechnung und MDK-Abrechnungsprüfung”. Projektbericht im Auftrag des Verband der Ersatzkassen e. V. (vdek).

Augurzky, B., Haering, A. and S. Reif (2019) “Ausbildungspauschalen für die generalistische Pflegeausbildung in NRW - Endbericht”. RWI Projektbericht im Auftrag der Krankenhausgesellschaft Nordrhein-Westfalen.