Skewed, persistent and high before death: Medical spending in Germany

Martin Karlsson, Tobias Klein, Nicolas Ziebarth

Research output: Contribution to journalArticleScientificpeer-review

19 Citations (Scopus)


We use claims panel data from a big German private health insurer to provide detailed individual-level evidence on medical spending between 2005 and 2011. This includes evidence on the distribution of medical spending, the dependence of medical spending on age and other demographic characteristics, its persistence, and how medical spending evolves in the years before death. Our main findings are that health care spending more than doubles between ages 50 and 80 and that spending is very concentrated: the top 10% of all spenders are responsible for 53% of all medical spending in a given year. There is a fifty
percent probability that individual expenditures lie in the same quintile of the distribution after five years, both for very high and very low cost individuals. Medical spending in the year before death is six times higher for the deceased, as compared to spending of everybody else, and accounts for 5.6% of lifetime spending. Females use more outpatient care and have higher spending in younger ages, whereas males have higher spending in older ages, particularly for inpatient care, and die younger. The presentation of these empirical facts is framed by an institutional discussion of the German health care system, a comparison between publicly and privately insured, and a discussion of medical spending trends in aggregate-level data.
Original languageEnglish
Pages (from-to)527-559
JournalFiscal Studies
Issue number3-4
Publication statusPublished - Sept 2016


  • health care spending
  • Germany
  • sickness funds
  • private health insurance system
  • concentration of health expenditures


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