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Background and objective
Political, economic, communicative and cultural borders still limit the accessibility of acute healthcare services for patients so that they frequently have to accept longer distances to travel to the next provider within their own country. In this paper, we analyze the impact of borders and opening of borders on acute medical care in hospitals and on patients in border regions.
Methods
We develop a conceptual framework model of cross-border healthcare and apply it to the Polish–German border area. The model combines the distance decay effect, a catchment area analysis, economies of scale and the learning curve.
Results
Borders have a major impact on acute medical care in hospitals and on patients. Setting of new borders will reduce the accessibility of health facilities for patients or require the establishment of new hospitals. Reopening borders might induce a vicious circle leading to the insolvency of a hospital which might result in poorer health for some patients.
Conclusion
Strong effort should be invested to overcome political and cultural borders to improve the health of the population in border regions. Similarly, increased cross-border acute healthcare must be seen in the context of rural health and the special situation of small rural hospitals in rural peripheral areas.
Parental gender preferences in Central and Eastern Europe and differential early life disadvantages
(2023)
Parental gender preferences may affect partnership decisions and as a result lead to early life disadvantages. We study these preferences in five post-communist countries of Central and Eastern Europe, a region with strong traditional gender norms and persisting inequalities between women and men in labour market outcomes. Using subsamples of census from Belarus, Hungary, Poland, Romania and Russia around 2000 and 2010, we follow Dahl and Moretti (2008), The demand for sons, to examine the effect of the gender of the first-born child(ren) on fertility decisions and relationship stability of their parents. We only find strong evidence of ‘boy preferences’ in fertility decisions in the cases of Romania and Russia. However, unlike Dahl and Moretti (2008), The demand for sons, for the US, we cannot confirm a relationship between the children's gender and parental partnership decisions. This is the case for all examined Central and Eastern European countries, as well as for a number of countries from Western Europe. The cases of Romania and Russia raise questions about other potential consequences of the documented gender preferences. We argue that our approach can be applied more broadly to identify other countries characterised by parental gender preferences, and to motivate further examination of different forms of gender driven early life disadvantages.
Aim
A shortage in primary care physicians has been a well-known challenge in many Western countries for several years. In addition, we currently see a trend in primary care, where an increasing number of physicians work as employees instead of being self-employed, even among general practitioners. To address this shortage, knowledge of the future specialists’ attitudes toward working self-employed is needed. This qualitative systematic review aims to explore the attitudes of future specialists towards self-employment in private practice, and what factors influence these attitudes.
Subject and methods
We conducted a systematic search using PubMed, Embase, and Web of Science. We developed a search strategy that collected terms for future specialists, career choices, and self-employment and linked these with the Boolean operator “AND”. We analysed the results using a qualitative content analysis, as both qualitative and quantitative studies were included in the research.
Results
Self-employment is less attractive to future specialists. In particular, women prefer to be employed and receive a fixed salary. The main factors that influence the decision as to whether to become self-employed or not are financial conditions, bureaucracy and non-medical tasks, organisation, job satisfaction during residency, personal responsibility, career opportunities, specialty-dependent factors, personal environment, and education.
Conclusion
Among future specialists, being self-employed is less attractive than being an employee. Students should be better informed about future career opportunities to make an informed decision. However, it should be examined whether other forms of organisation are more in line with the wishes of future specialists.
Background
Out-of-hospital cardiac arrest is one of the most frequent causes of death in Europe. Emergency medical services often struggle to reach the patient in time, particularly in rural areas. To improve outcome, early defibrillation is required which significantly increases neurologically intact survival. Consequently, many countries place Automated External Defibrillators (AED) in accessible public locations. However, these stationary devices are frequently not available out of hours or too far away in emergencies. An innovative approach to mustering AED is the use of unmanned aerial systems (UAS), which deliver the device to the scene.
Methods
This paper evaluates the economic implications of stationary AED versus airborne delivery using scenario-based cost analysis. As an example, we focus on the rural district of Vorpommern-Greifswald in Germany. Formulae are developed to calculate the cost of stationary and airborne AED networks. Scenarios include different catchment areas, delivery times and unit costs.
Results
UAS-based delivery of AEDs is more cost-efficient than maintaining traditional stationary networks. The results show that equipping cardiac arrest hot spots in the district of Vorpommern-Greifswald with airborne AEDs with a response time < 4 min is an effective method to decrease the time to the first defibrillation The district of Vorpommern-Greifswald would require 45 airborne AEDs resulting in annual costs of at least 1,451,160 €.
Conclusion
In rural areas, implementing an UAS-based AED system is both more effective and cost-efficient than the conventional stationary solution. When regarding urban areas and hot spots of OHCA, complementing the airborne network with stationary AEDs is advisable.
Background
Medical research is increasingly interdisciplinary. However, not all projects are successful and cooperation is not always sustained beyond the end of funding. This study empirically assesses the effect of control and trust on the sustainability of interdisciplinary medical research in terms of its performance and satisfaction.
Methods
The sample consists of 100 German publicly funded medical research collaborations with scientists from medicine, natural and social sciences (N = 364). We develop a system model to analyze the influence of trust and control on performance and satisfaction of the cooperation.
Findings
Both control and trust are important prerequisites for sustainability, control mainly for the performance of the collaboration, and trust primarily for its satisfaction. While the level of interdisciplinarity is a positive moderator for performance, expectation of continuity is a negative intervening variable for the effect of trust and control on satisfaction. Moreover, trust principally adds to the positive impact of control on sustainability.
Conclusions
Interdisciplinary medical research requires a participative but systematic management of the respective consortium.
Background
Despite the current undersupply of cochlear implants (CIs) with simultaneously increasing indication, CI implantation numbers in Germany still are at a relatively low level.
Methods
As there are hardly any solid forecasts available in the literature, we develop a System Dynamics model that forecasts the number and costs of CI implantations in adults for 40 years from a social health insurance (SHI) perspective.
Results
CI demand will grow marginally by demographic changes causing average annual costs of about 538 million €. Medical-technical progress with following relaxed indication criteria and patients’ increasing willingness for implantation will increase implantation numbers significantly with average annual costs of 765 million €.
Conclusion
CI demand by adults will increase in the future, thus will the costs for CI supply. Continuous research and development in CI technology and supply is crucial to ensure long-term financing of the growing CI demand through cost-reducing innovations.
Strategic Management in Healthcare: A Call for Long-Term and Systems-Thinking in an Uncertain System
(2022)
Strategic management is becoming increasingly important for sustainable management in healthcare. The reasons for this can be seen in the increasing complexity, dynamics and uncertainty of the system’s regimes and the resulting need for strategic thinking in a long-term period. The scientific discussion of this issue is the aim of the present analytical framework. The starting point is the definition of the term strategic management itself, followed by a reflection on the requirements resulting from the changes in the political, social and economic value systems of our post-industrial society. In this context, Dynaxity Zone III is used to explain the long-term perspective, the high levels of complexity and uncertainty and the responsibility of strategic management as important parameters. For a practical illustration, we demonstrate two selected applications (German hospital financing systems and development process of implants) and how the implementation of strategic management in the health care system shows success.
In 2009, the Democratic Republic of Congo (DRC) started its journey towards achieving Universal Health Coverage (UHC). This study examines the evolution of financial risk protection and health outcomes indicators in the context of the commitment of DRC to UHC. To measure the effects of such a commitment on financial risk protection and health outcomes indicators, we analyse whether changes have occurred over the last two decades and, if applicable, when these changes happened. Using five variables as indicators for the measurement of the financial risk protection component, there as well retained three indicators to measure health outcomes. To identify time-related effects, we applied the parametric approach of breakpoint regression to detect whether the UHC journey has brought change and when exactly the change has occurred.
Although there is a slight improvement in the financial risk protection indicators, we found that the adopted strategies have fostered access to healthcare for the wealthiest quantile of the population while neglecting the majority of the poorest. The government did not thrive persistently over the past decade to meet its commitment to allocate adequate funds to health expenditures. In addition, the support from donors appears to be unstable, unpredictable and unsustainable. We found a slight improvement in health outcomes attributable to direct investment in building health centres by the private sector and international organizations. Overall, our findings reveal that the prevention of catastrophic health expenditure is still not sufficiently prioritized by the country, and mostly for the majority of the poorest. Therefore, our work suggests that DRC’s UHC journey has slightly contributed to improve the financial risk protection and health outcomes indicators but much effort should be undertaken.
Background
This study aimed to analyze the impact of low-value medications (Lvm), that is, medications unlikely to benefit patients but to cause harm, on patient-centered outcomes over 24 months.
Methods
This analysis was based on longitudinal data of patients with dementia. The impact of Lvm on health-related quality of life (HRQoL), hospitalizations, and health care costs were assessed using multiple regression models.
Results
Over 24 months, Lvm was highly prevalent and significantly increased the risk of hospitalization, increased health care costs, and reduced patients' HRQoL.
Conclusion
More than every second patient received Lvm, negatively impacting patient-reported HRQoL, hospitalizations, and costs. Innovative approaches are needed to encourage prescribers to avoid and replace Lvm in dementia care.
Nowadays, a challenge in wildlife management and nature conservation is to reach a state of human-wildlife coexistence, integrating wildlife into the human-dominated landscape. Achieving a state of coexistence is urgent as human-wildlife conflicts increase over time. Thus a "route guide" for researchers and conservation practitioners will be needed to identify if a human-wildlife interaction is heading towards conflict or coexistence, enabling them to conduct management activities, when possible, to achieve human-wildlife coexistence. Researchers have used different individual-based attributes as a proxy to measure support towards wildlife species by the general public. Different operationalizations from Environmental Economics and Environmental and Conservation Psychology research fields have been used to measure support. Examples of operationalization are the willingness-to-pay and Likert-type scale, or rating scale, from the first and second research fields. In the first, participants must indicate how much they would be willing to pay to protect a specific wildlife species population in a particular area and time. In the second, participants are asked to rate statements through, e.g., a five-point ordinal rating scale with opposite alternatives between, e.g., strongly agree and strongly disagree. In the human dimension of natural resources management research, variations of these methodologies have been used to measure support, not only for one wildlife species but for a set. For the willingness-to-pay variation, i.e., money allocation, participants must distribute a constant sum of money among a set of wildlife species. For the rating scale variation, each of the wildlife species in the set corresponds to a statement to be rated. The thesis aims to contrast these two variations, i.e., money allocation and rating scale, in their capacity to assess support changes towards a set of 12 native wildlife species from different taxa.
A survey was applied in 2018 (n: 368) and replicated in 2019 (n: 359) among urban dwellers who cohabit with the wildlife species set, in Valdivia, south of Chile. The surveys were applied before and after information disclosure and exposure in an experimental and longitudinal research design structure, respectively. As information disclosure, the threatened and endemic status of the wildlife species was presented to the participants. On the other hand, mass media coverage of a human-wildlife conflict involving one of the species included in study, the South American Sea Lion, was used for information exposure. The results indicate that the money allocation method identified support changes among the wildlife species to a greater extent than the rating scale for both types of information (Chapters 2, 3, and 4). The money allocation in the experimental design structure grouped the wildlife species based on their threatened and endemic status, while the rating scale did not come with the same results (Chapter 3). In the longitudinal design structure, the South American Sea Lion support decreased based on the average values of the money allocation and rating scale after the information exposure (Chapter 4). Differently, when the South American Sea Lion position support is compared with the other wildlife species, based on the money allocation, there was a descent, while the rating scale presented an ascent after the mass media coverage of the human-wildlife conflict (Chapter 4). This difference between the results of the two methods, in both research design structures, can be explained to a certain extent due to their scaling technique characteristics. The money allocation is a comparative scale; therefore, the support given to one wildlife species will affect the possible support given to the other species. In contrast, the rating scale is a non-comparative scale, i.e., the support given to a wildlife species is independent of the support given to the other wildlife species in the set. In the experimental research design structure (Chapters 2 and 3), to give or increase the support to a threatened or endemic wildlife species, a bill should be taken from another wildlife species, usually not threatened nor endemic. On the contrary, in the rating scale, there was no need to choose; the support could be increased for a wildlife species without decreasing the support for other wildlife species. In the longitudinal study design structure, the money allocation allows direct comparison between wildlife species from one year to another, while the rating scale does not. For the money allocation, the possible amount of support to be given to a wildlife species, i.e., 12 bills of 1,000 CLP each, did not vary from 2018 to 2019. For the rating scale, the values received among the wildlife species can vary within the rating scale from one year to another, misleading to incorrect interpretations. The money allocation method can be suitable for monitoring human-wildlife interactions, i.e., to position and visualize support shifts. The money allocation could be used as an overview of human-wildlife interactions in a specific area, working as a first assessment.
Background and objective
The COVID-19 pandemic started in Wuhan, China, in December 2019. Although there are some doubts about the reporting of cases and deaths in China, it seems that this country was able to control the epidemic more effectively than many other countries. In this paper, we would like to analyze the measures taken in China and compare them with other countries in order to find out what they can learn from China.
Methods
We develop a system dynamics model of the COVID-19 pandemic in Wuhan. Based on a number of simulations we analyze the impact of changing parameters, such as contact rates, on the development of a second wave.
Results
Although China’s health care system seems to be poorly financed and inefficient, the epidemic was brought under control in a comparably short period of time and no second wave was experienced in Wuhan until today. The measures to contain the epidemic do not differ from what was implemented in other countries, but China applied them very early and rigorously. For instance, the consequent implementation of health codes and contact-tracking technology contributed to contain the disease and effectively prevented the second and third waves.
Conclusions
China’s success in fighting COVID-19 is based on a very strict implementation of a set of measures, including digital management. While other countries discuss relaxing the lock-down at a rate of 50 per 100,000 inhabitants, China started local lock-downs at a rate of 1.59 per 100,000. We call for a public debate whether this policy would be feasible for more liberal countries as well.
External effects of agglomeration and human capital is a more than a century old research topic. Their theory and empirics have evolved over time to interact with more economic factors and to dig more deeply into heterogeneous effects, whose empirical evidence remains scarce, especially for developing countries. Furthermore, local human capital and agglomeration are often introduced in separate models rather than a single model in explaining productivity. These limitations motivate the implementation of this thesis. To achieve this, firm-level panel data from Vietnam is employed. This developing country provides an interesting case because its level of agglomeration and human capital is still low but its socio-economic conditions are highly dynamic with the high growth rates of urbanization and university-educated labor force (production inputs) as well as income (production output), in comparison with developed countries. The heart of this thesis lies on its chapter 2 and chapter 3, which are summarized as follows.
Chapter 2 aims at finding which agglomeration forces play the dominant role in affecting firms’ productivity and how agglomeration induces unequal influences across various firm characteristics. To achieve this, a six-year panel data set is employed, and the estimation is based on a production function that the left-hand side is firm’s total factor productivity while the righthand side is local technology which contains the agglomeration terms. In the first step of regression, consistent values of productivity are obtained following a strategy that combines the control function approach with the instrumental variables technique to tackle endogeneity caused by a possibility that firms choose their production inputs based on their productivity. In the second step, log of productivity is regressed on agglomeration proxies and controls, using multiple fixedeffects terms to control for unobserved factors and local shocks. Estimated results show that urbanization rather than specialization has a positive impact on productivity. Besides, the agglomeration effects are stronger for foreign-owned, small-sized, or young firms.
Chapter 3 shows attempts to find evidence of human capital externalities along with urbanization economies, given that the two external terms are rarely placed together in a single specification in literature. The estimation is implemented based on a production function whose context is an unique spatial equilibrium resulting from migration behaviors of entrepreneurs and workers. In this function, the externalities play the role of a region-specific productivity shifter. The model is regressed primarily with the instrumental variables technique to tackle possible identification problems. Between the two external terms, the resulting estimates confirm only the existence of urbanization economies. However, human capital externalities are found to be strong and significant in high-tech industries, implying that the effects of local human capital are very heterogeneous across different technological levels.
Abstract
This paper focuses on the expectation formation process of professional forecasters by relying on survey data on forecasts regarding gross domestic product growth, consumer price index inflation and 3‐month interest rates for a broad set of countries. We examine the interrelation between macroeconomic forecasts and also the impact of uncertainty on forecasts by allowing for cross‐country interdependencies and time variation in the coefficients. We find that professional forecasts are often in line with the Taylor rule and identify significant expectation spillovers from monetary policy in the USA.
Abstract
This article takes a novel look at the relationship between government activity, partisan preferences and varieties of capitalism. Evidence from panel regressions for 25 EU countries from 1990 to 2014 suggests that there are major divides among European countries in terms of the drivers of government activity, that is, government spending and government regulation. The European divide appears to be even more pronounced between liberal and coordinated economic systems than between the classical geographical divide of east and west, which is typically used in most contributions. While both divides apply to the determinants of government activity in general, a reversal of the classical partisan effect for the east is to be found only in specific cases and, is most likely in government spending in liberal eastern countries.
Purpose: To assess the comparative efficacy and the long-term cost-utility of alternative minimally invasive glaucoma surgeries (MIGSs) when combined with cataract surgery in patients with primary open-angle glaucoma (POAG).
Methods: Treatment effects, as measured by the 1-year reduction in intraocular pressure (IOP), were estimated with an adjusted indirect treatment comparison. Evidence from randomized clinical trials was identified for four different MIGS methods. A disease-transition model was developed by capturing clinically relevant POAG stages and the expected natural disease evolution. Outcomes of the disease-transition model were the comparative utility [quality-adjusted life years (QALYs)], cost and cost-utility of included strategies in a lifetime horizon.
Results: Estimated 1-year IOP reductions were: cataract surgery - 2.05 mmHg (95% CI - 3.38; - 0.72), one trabecular micro-bypass stent - 3.15 mmHg (95% CI - 5.66; - 0.64), two trabecular micro-bypass stents - 4.85 mmHg (95% CI - 7.71; - 1.99) and intracanalicular scaffold - 2.25 mmHg (95% CI - 4.87; 0.37). Discounted outcomes from the disease-transition model appraised the strategy of two trabecular micro-bypass stents with cataract surgery in the moderate POAG stage as the one providing the greatest added value, with 10,955€ per additional QALY. Improved outcomes were seen when assessing MIGS in the moderate POAG stage.
Conclusions: When indirectly comparing alternative MIGS methods combined with cataract surgery, the option of two trabecular micro-bypass stents showed both a superior efficacy and long-term cost-utility from a German perspective. Moreover, outcomes of the disease-transition model suggest POAG patients to beneficiate the most from an earlier intervention in the moderate stage contrary to waiting until an advanced disease is present.
The purpose of this study was to compare the effect of culture on consumers’ attitudes toward Cause-Related marketing between Iran and Germany by answering the following questions:
A: What is consumer’s response concerning (1) skepticism toward CRM claim (2) attitude toward the CRM strategy, (3) attitude toward CRM brand personality, (4) attitude toward the CRM brand image and (5) CRM purchase intention (6) Warm glow? ; B: Do consumers respond differently to Cause-Related Marketing in Iran in comparison to Germany? C: Can cultural characteristics of the countries explain these differences? To answer the research questions, hypotheses were developed based on the literature which shape the research framework, in total containing 17 hypotheses. The data was gathered by questionnaire to make the research quantitative. By using convenience sampling, 564 responses were generated. The data was analysed by Structural Equation Modeling (SEM) and independent student t-test. Potential differences between Iran and Germany as well as moderation analysis are tested by critical ratio difference test as well as chi-square difference test using multiple- group analysis in AMOS. The results showed the importance of culture in applying CRM strategy. It can be said that CRM in a collectivistic culture like Iran can be successful as well as individualistic country like Germany. Although Iranian consumers were less familiar with this strategy, the benefits of CRM were similar in case of brand image and higher for purchase intention. The research found that emotions play a stronger role in Iran and it is more critical to evoke proper emotions by CRM campaign.