Provision of health care services and regional diversity in Germany: insights from a Bayesian health frontier analysis with spatial dependencies

  • Rouven Edgar HaschkaEmail author
  • Katharina Schley
  • Helmut Herwartz
Original Paper


The German health care system is among the most patient-oriented systems in Europe. Nevertheless, distinct utilisation patterns, access barriers due to socio-economic profiles, and potentials of misallocation of medical resources lead to disparities in the provision of health care services. We analyse how a possible over- and undersupply of services and the utilisation of and the access to the health care system relate to regional variations in the population’s well-being. For this purpose, we employ a recent Bayesian stochastic frontier approach that allows for spatial dependence structures. Our results indicate that patient migration plays an important role in contributing to regional differences in the utilisation of the medical infrastructure. As a consequence, policy should take spatial patterns of health care utilisation into account to improve the allocation of medical resources.


Health production Health efficiency Stochastic frontier analysis Oversupply of medical services Regional misallocation Bayesian estimation Regional and spatial modelling Markov-chain–Monte Carlo simulation 

JEL Classification

C23 D61 I11 I18 R10 



Financial support by the German Research Association (DFG) Research Training Group 1644 ‘Scaling problems in Statistics’, Grant no. 152112243, is gratefully acknowledged. Helpful comments from two anonymous referees are also gratefully acknowledged.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Rouven Edgar Haschka
    • 1
    Email author
  • Katharina Schley
    • 1
  • Helmut Herwartz
    • 1
  1. 1.Georg-August University of GöttingenGöttingenGermany

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