Institut für Health Care & Public Management

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Ageing and productivity
(2013) Bloom, David E.; Sousa-Poza, Alfonso
Arbeitszeitmodelle im Schweizer Gesundheitswesen : qualitative Untersuchung in der Maximalversorgung
(2023) Linggi, Michael; Ernst, Christian
Research into the working time models of physicians is of great importance to ensure the health and safety of patients, to improve the well-being and satisfaction of medical staff, to increase the efficiency of work processes and to counteract the shortage of labor. The dissertation discusses the different working time models in the Swiss health care system, especially in the field of maximum care. It shows the working time models applied in practice as well as the challenges arising from their implemen-tation. It concentrates on the field of surgery (cutting discipline), but is not limited to specific surgical specialties, but follows a generalist approach. The aim of the re-search is to show which working time models function in the complex daily work of physicians in the Swiss model of maximum care and to what extent they can be transferred to other levels of care and countries. Due to the complexity of the topic, the research question was answered with the help of qualitative interviews. Both phy-sicians and administrative staff were interviewed. By means of qualitative content analysis, the various categories were then formed in order to be able to classify the transcribed text passages. The dissertation is based on the results of current research, for which primarily the contributions of generalist research were used. It has been shown that the organiza-tion of working time has a considerable influence on the satisfaction and health of employees. In particular, 24-hour operations and the associated shift patterns play an important role. Theoretical approaches to human, social and psychological capital al-so illustrate why employees are one of a companys most important resources. This forms the basis for the presentation of different working time models and the identifi-cation of influencing factors. Future-oriented aspects are also taken into account, such as the possibility of using robots in surgery to perform various procedures, which opens up additional options for designing new working time models. The findings of the dissertation can be summarized as follows: It is important to con-sider working time models in a global context, as the topic is very complex and multi-factorial. Basically, three levels can be identified that have to be considered when de-veloping innovative working time models: Society, institution and individual. In order to make new working time models possible, structural, societal prerequisites such as the Working Time Act and family-friendly framework conditions are needed. In addition, the institution, i.e. the hospital, must have the courage to break new ground and give employees the opportunity to work in new working time models. Finally, it is also up to the physicians to take personal responsibility and not take advantage of the employer. In addition to this overall approach with the three levels, the following focal points could be derived: Everyday work, work-life balance, research, education and training, career, work content, digitalization and other focal points. These focal points show which topics must be taken into account when developing new working time models. Finally, four working time models were identified as the most common: Part-time, Protected Time, Job Sharing and Home Office. In addition, labor legislation must cre-ate the framework conditions to enable these models to be used in a meaningful way. The findings are transferable to clinics and hospitals in other countries with a competi-tive health insurance system, such as Germany or Austria. This means that the find-ings and recommendations for improving working time models should also be appli-cable in similar legal and organizational contexts. This dissertation on the study of working time models among physicians at the high-est level of care provides an important basis for the further development of such models. The holistic view of the topic and the identification of challenges and focal points contribute to the improvement of future working time models. Hospital and clin-ic management should take these results into account when planning and implement-ing working time models. For future research, similar studies could be conducted in other countries.
Aspects of demand-side oriented insurance of volatile food prices in developing and emerging countries
(2018) Hochscherf, Julian; Schiller, Jörg
The dissertation is concerned with the relation between formal and informal risk management in developing and emerging countries in the context of rainfall and food price variability. The dissertation contains three research projects. In order to systematize the literature on welfare effects of food price volatility and rainfall risks and the related coping strategies, a systematic review on the quantification of these two risk types has been performed. Many studies in the recent past have been published to quantify poverty effects of materialized risk such as drought events or the consequence of the 2008-09 food price crises in emerging and least developed countries. As agrarian economies in least developed countries heavily depend on the correct onset and amount of rainfall quantities, rainfall failures are likely to have adverse consequences for household income and its volatility. In addition, agrarian households in least developed countries are mostly net food consumers and thus highly dependent on the realization of food prices. The review systematizes the empirical evidence on adverse income effects of drought events and food price increases as well as it summarizes the risk management and coping strategies directly linked to these two shock types. A particular emphasis will be given to the stabilizing power of labor markets and adaptation through consumption responses. The second paper is concerned with informal risk management strategies taken out by agricultural households, in particular with the instrument of labor time allocation. Subsistence farmers in low income countries are confronted with multiple risks. In reaction to them, farm households have developed strategies to cope with yield risks to self-insure against these income shocks. Recent developments in global food markets have increased food price volatility, which, in particular, puts low-income households at risk. When small-scale farmers allocate their labor time over different income generating activities, they face the risk of uncertain purchasing power of income in the presence of food price variability. Thus, the paper analyzes the labor time allocation decision between self-employment and wage labor, taking into account the uncertain purchasing power of wages resulting from food price volatility and the farm production risk induced by rainfall variability. Using a panel structured household data set containing consumer-producer households in rural India, the labor time allocation decision between farming and labor market participation will be analyzed and the effect of production and food price uncertainty on labor time allocation will be estimated. The analysis reveals counterintuitive time allocation effects of risk. The third project is concerned with formal insurance demand by farm households and the interrelatedness between formal and informal risk provision. For this purpose, a data set for a weather index insurance demand product has been analyzed. Index based microinsurance as a tool to insure the income of agriculturally active households has triggered extensive discussions in the literature. Despite the convincing theoretical argumentation, the demand for these products stays behind expectations. Several studies revealed effects impacting the demand for index insurance, such as liquidity constraints, basis risk, lack of understanding and trust in insurers and products alike. This paper takes a different perspective and hypothesizes that low demand is due to heterogeneous risk exposure towards weather variability among potential insured resulting from informal risk management. The paper tests the impact of income heterogeneity as a measure of risk exposure on insurance demand and finds that risk exposure negatively affects insurance demand. In order to increase demand, it is concluded that product design should emphasize more the importance of income risk composition and exposure of potentially insured. The dissertation concludes with a critical discussion of how to reconcile formal and informal risk management practices and gives policy implications of how to innovate existing formal insurance products to increase demand.
Automatische Prozessüberwachung in der Nutztierhaltung : Gestaltung eines Verfahrens zur Extraktion von Prozessindikatoren aus Bilddaten mittels Deep Learning
(2024) Riekert, Martin; Kirn, Stefan
Der Gegenstand der Arbeit sind Verfahren zur Erkennung der Prozessindikatoren zum Liegeverhaltens von Schweinen aus Videobildern. Das Liegeverhalten eines Schweines ist definiert als dessen Position im Stallbereich und ob es liegt oder nicht liegt. Hierzu zeichnen in Stallbereichen installierte Kameras kontinuierlich Videobilder auf, die hinsichtlich des Liegeverhaltens der abgebildeten Schweine analysiert werden. Die Stallposition im Tagesverlauf und die Liegehäufigkeit sind wichtige Prozessindikatoren in der Schweinehaltung. Die Problemstellung liegt in der Korrektheit der Erkennung der Prozessindikatoren zum Liegeverhalten. Bisherige Verfahren treffen zwei Annahmen: Erstens werden nur zur Tageszeit aufgenommene Videobilder verarbeitet, sodass das Liegeverhalten im Dauerbetrieb und insbesondere der Nacht und Dämmerung unerkannt bleibt. Zweitens setzen die Verfahren Homogenität der Stallbereiche voraus, sodass alle Stallbereiche ähnliche physische Eigenschaften besitzen. Diese Annahme beschränkt die Eignung der Verfahren für unbekannte Stallbereiche. Die Problemstellung wird aus der Perspektive des Deep Learning untersucht. Die vorliegende Arbeit trägt zur automatischen kontinuierlichen Erfassung der Position und der Körperhaltung von Schweinen unter Verwendung von handelsüblichen 2D-Kameras in realen Umgebungen unter verschiedenen Lichtbedingungen und Kameraausrichtungen rund um die Uhr bei. In der vorliegenden Arbeit wird untersucht, wie Deep-Learning-Verfahren angewendet und gestaltet werden können, um unter realen Bedingungen kontinuierlich eine hohen mean Average Precision zu erzielen und welche Einschränkungen bei der Anwendung von Deep-Learning-Verfahren bestehen. Das gestaltete und evaluierte Verfahren ermöglicht die Erkennung von Schweinen in einer großen Anzahl verschiedener Ställe, dies beinhaltet das Liegeverhaltens unter Verwendung realistischer Kamera- und Beleuchtungseinstellungen (inkl. Nachtaufnahmen mittels Nahinfrarot).
Beitrittsentscheidungen zu Multiagenten-Organisationen : ein Revenue Management-basierter Ansatz
(2018) Premm, Marc; Kirn, Stefan
Der Forschungsbereich Multiagentensysteme hat sich seit den späten 1970er Jahren als Teilbereich der verteilten künstlichen Intelligenz (VKI) etabliert. Gegenstand dieses Forschungsbereichs sowie dieser Arbeit sind Softwareagenten, die als Softwaresysteme zielorientiert agieren und mittels Lernverfahren eine gewisse Autonomie gegenüber ihrem Entwickler erlangen. Softwareagenten ist es möglich, sich zu Multiagentensystemen zusammenzuschließen. Multiagentensysteme sind folglich offene Systeme, aus denen Softwareagenten ein- und wieder austreten können – im Allgemeinen ohne globale Kontrolle. Hieraus ergibt sich eine gewisse Flüchtigkeit sowohl der Mitgliedermenge als auch der Interaktionsstrukturen eines Multiagentensystems und somit eine eingeschränkte Möglichkeit zur Steuerung des nach außen hin wahrnehmbaren Systemverhaltens, welcher es beim Einsatz von Softwareagenten in kommerziellen Anwendungen im Allgemeinen bedarf. Multiagenten-Organisationen bilden einen Ansatz um die betriebswirtschaftliche Organisationstheorie zur internen Strukturierung von Multiagentensystemen zu nutzen und folglich auch deren Außenverhalten zielgerichtet zu steuern. Diese Arbeit versteht Multiagenten-Organisationen als auf Dauerhaftigkeit ausgelegte Zusammenschlüsse von mehreren unabhängigen Softwareagenten, die durch vertragliche Regelungen an der Erfüllung eines vorgegebenen Organisationsziels mitwirken. Softwareagenten benötigten Zugriff auf Ressourcen um einerseits bestimmte Dienste anbieten (z.B. Datenbank-Zugriff) aber auch um ihre eigene Ausführung sicherstellen zu können (z.B. Hardwareressourcen). Softwareagenten können die ihnen zur Verfügung stehenden Ressourcen nutzen um einer Multiagenten-Organisation im Rahmen einer Mitgliedschaft Dienste zur Verfügung zu stellen. Die Erbringung von Diensten konsumiert stets einen Teil der einem Softwareagenten zur Verfügung stehenden Ressourcen. Softwareagenten werden daher einer Multiagenten-Organisation Dienste nur gegen eine entsprechende Kompensation zur Verfügung stellen. Der Beitritt eines Softwareagenten zu einer Multiagenten-Organisation ist stets das Ergebnis von Beitrittsverhandlungen zwischen diesen beiden Akteuren, in denen neben den bereitzustellenden Diensten und der zu zahlenden Kompensation, insbesondere die Dienstgüte verhandelt wird. Softwareagenten können dabei Mitglied in mehreren Multiagenten-Organisationen sein. Jeder Softwareagent hat hierbei zu entscheiden, ob bzw. welcher Multiagenten-Organisation er beitritt und in welchem Umfang er die verfügbaren Ressourcen hierfür einsetzt. Dabei hat er bereits bestehende Mitgliedschaften in anderen Multiagenten-Organisationen, für die der Softwareagent bereits Dienste bereitstellt und somit Ressourcen auslastet, bei der Beitrittsentscheidung mit zu berücksichtigen. Hieraus lässt sich folgende Forschungsfrage ableiten: Wie sind Entscheidungsverfahren auszugestalten, die es Softwareagenten ermöglichen, nutzenmaximierende Beitrittsentscheidungen zu Multiagenten-Organisationen zu treffen? Diese Arbeit präsentiert ein Verfahren zur Optimierung von Beitrittsentscheidungen von Softwareagenten zu Multiagenten-Organisationen. Das entwickelte Verfahren basiert auf Ansätzen des Revenue Management als Teilbereich des Operations Research. Die in der Literatur vorhandenen Verfahren des Revenue Management sind dabei nicht in der Lage, die Gegebenheiten von Beitritts-entscheidungen von Softwareagenten abzubilden. Das entwickelte Revenue Management-basierte Modell der Beitrittsentscheidung versetzt Softwareagenten in die Lage Mitgliedschaften in Multiagenten-Organisationen zu bewerten, deren Dauer a-priori unbekannt ist, und potentielle Mitgliedschaften anhand verschiedener Dienstgüteklassen abzugrenzen. Das entwickelte Verfahren nutzt die auf dieser Basis vorhandenen Möglichkeiten der Optimierung von Beitritts¬entscheidungen, greift den Ansatz von Ressourcen-bezogenen Reservationspreisen (so genannten Bid-Prices) aus dem Revenue Management auf und passt diesen auf die Gegebenheit von Beitritts¬entscheidungen von Softwareagenten an. Das entwickelte Verfahren wird durch ein Simulationsexperiment auf ihre Wirksamkeit und die hierfür notwendigen Bedingungen hin evaluiert. Zur Erreichung dieser Ziele wird ein Referenz- Entscheidungsverfahren herangezogen und verschiedene Parameter der Simulation jeweils paarweise variiert. In der Mehrzahl der untersuchten Parameterkonstellationen erzielt das entwickelte Verfahren eine Steigerung der erwirtschafteten Kompensation. Softwareagenten, die in einer Domäne Dienste anbieten, in der diese Parameterkonstellationen vorzufinden sind, werden durch die Anwendung des Verfahrens in die Lage versetzt, höhere Kompensationen durch Mitgliedschaften in Multiagenten-Organisationen zu erzielen als mit dem Referenz-Entscheidungsverfahren. Sind dem Softwareagenten einzelne Parameter a-priori nicht bekannt, kann mit Hilfe dieser simulativen Evaluation bereits das Risiko des Einsatzes des Verfahrens abgeschätzt werden. Das entwickelte Verfahren konnte jedoch nicht für alle Parameterkonstellationen einen Vorteil erwirtschaften, so dass für die Anwendung zwei wesentliche Voraussetzungen zu beachten sind: (1) Differenzierungsmöglichkeiten. Grundvoraussetzung für die Anwendung des Verfahrens ist die Möglichkeit der Differenzierung und den damit verbundenen Unterschieden in der Höhe der erzielten Kompensation bei gleichem Ressourceneinsatz. Diese Differenzierung kann durch verschiedene Maßnahmen des Softwareagenten erreicht werden: (i) Für verschiedene Dienste mit gleichem Ressourcenbedarf werden unterschiedlich hohe Kompensationsforderungen gestellt, (ii) ein oder mehrere Dienste werden in unterschiedlichen Dienstgüteklassen angeboten, deren Kompensationen sich in ausreichendem Maße unterscheiden oder (iii) verschiedene Dienste nutzen eine unterschiedliche Menge an Ressourcen. (2) Nachfrage. Das in dieser Arbeit entwickelte Bid-Price-Verfahren kann nur durch Ablehnen von bestimmten Anfragen Vorteile gegenüber dem Referenz-Entscheidungsverfahren generieren. Voraussetzung ist somit eine entsprechende Nachfrage nach den angebotenen Diensten eines Softwareagenten und somit nach dessen Mitgliedschaft in Multiagenten-Organisationen. Steht diese Nachfrage nicht in ausreichendem Maße zur Verfügung, kann im Allgemeinen kein Vorteil gegenüber anderen Ansätzen erzielt werden. Abhängig von der individuellen Situation an angebotenen Diensten wirkt sich auch ein bestimmtes Verhältnis an nachfragenden Multiagenten-Organisationen positiv auf das Ergebnis des vorgestellten Verfahrens aus: Ist die überwiegende Zahl der Anfragen auf niederwertige Dienste oder Dienstgüteklassen ausgerichtet, jedoch auch eine ausreichend hohe Zahl an höherwertigen Anfragen vorhanden, erzielt das Verfahren deutliche Steigerungen gegenüber dem Referenz-Entscheidungsverfahren. Die voran genannten Voraussetzungen haben sich in der simulativen Evaluation als wesentlich für eine Vorteilhaftigkeit der Anwendung des entwickelten Verfahrens herausgestellt. Wenden Softwareagenten das entwickelte Verfahren für Beitrittsentscheidungen zu Multiagenten-Organisationen in Domänen an, die diese Voraussetzungen erfüllen, ist eine Steigerung der erwirtschafteten Kompensation gegenüber dem Referenz-Entscheidungsverfahren wahrscheinlich. Falls die Nachfrage kleiner als erwartet ausfällt, erzielte das Verfahren häufig die gleiche Kompensation wie das Referenz-Entscheidungsverfahren und erwirtschaftete nur in einzelnen Simulationsdurchläufen deutlich weniger, so dass selbst bei a-priori unbekannten oder unsicheren Parametern eine Anwendung des entwickelten Verfahrens möglich ist.
Commute time and subjective well-being in urban China
(2015) Sousa-Poza, Alfonso; Nie, Peng
Using data from the 2010 China Family Panel Studies, this study investigates the association between commute time and subjective well-being in a sample of 16- to 65-year-old employees in urban China. We find evidence that a longer commute time is associated with lower levels of both life satisfaction and happiness, especially when the commute times are extreme (≥ 1 hour per day). A multiple mediation analysis further indicates that the relation between commute time and happiness is partially mediated by time spent on daily activities, particularly sleeping. We calculate the amount of income necessary to compensate an employee’s loss in well-being at approximately 82 yuan per hour of commute time, implying that, in urban China, the annual loss of well-being amounts to around 10 billion yuan.
Economic problems of health insurance : reforms and competition
(2016) Lange, Renate; Schiller, Jörg
Although most modern societies agree that everyone should receive adequate access to medical treatment, health care systems worldwide vary greatly in terms of financing of health care costs, the provision of medical services, and regulatory aspects. Rising costs, economic downturns, and the demographic development have embraced the call for change particularly with regard to financing of health care costs and access to health insurance. Most health care systems have developed historically, but underwent fundamental changes as a consequence of policy decisions and reforms. Looking back on recent health reforms in the U.S. and Germany two divergent trends can be observed: Over the last two decades, German Statutory Health Insurance (SHI) primarily experienced benefit cuts and had to implement economic incentives and market-based instruments to a solidary-based social security model in order to overall contain costs. At the same time, recent health reforms in the U.S. have shown that a solely market-based health insurance system is hardly consistent with modern society’s ideas on fairness and distributive justice. Furthermore, the exclusion of large parts of the population from seeking health insurance as a result of high premiums is not only associated with high costs and negative effects (even for those holding insurance coverage), but overall seen as highly inefficient. This thesis aims to draw a comprehensive picture of economic problems of health insurance and, thereby, assesses economic goals and analyzes effects of recent health reforms in the two historically grown very different health insurance systems of Germany and the U.S. More specifically, three research questions will be addressed: First, looking at the demand for supplemental health insurance (SuppHI) in the aftermath of benefit reductions in German SHI, it investigates what factors drive the demand for SuppHI and what are possible sources of selection. Furthermore, this thesis offers new insights on what the two health insurance systems can learn and take over from each other. In this context, it discusses how new trends in health insurance in the U.S. (i.e. Health Savings Accounts (HSAs)) could be implemented in German SHI. The third focus of this thesis is on the mutual interdependence of public and private health insurance markets. Analyzing financial data of private health insurers in the U.S., it looks into the question of how premiums in Private Health Insurance (PHI) are affected by public health insurance programs (i.e. Medicaid).
Electronic service allocation with private quality information
(2017) Widmer, Tobias; Kirn, Stefan
The efficient allocation of electronic services is a complex business problem. Customers demand electronic services from service providers who supply these services at a specified quality of service (QoS). Electronic marketplaces provide a platform on which multiple customers and multiple providers negotiate the allocation of electronic services. Such marketplaces might be administrated by government authorities or large corporations who aim at a socially optimal allocation. This research addresses the allocation problem for electronic services with private quality information from a mechanism design perspective. By assigning specific reservation functions, multiple customers and multiple providers enunciate their preferences for these services. Once all demands and offers for electronic services are submitted, the mechanism determines an allocation that maximizes the sum of the aggregated preferences. However, the design of such mechanisms is difficult because of the following requirements: (1) Double-sided competition: Multiple competitive customers and multiple competitive providers must be matched together appropriately to generate maximal surplus, (2) QoS-awareness: The QoS desired by customers and the QoS offered by service providers must be internalized in the allocation mechanism, (3) private information: The mechanism must facilitate the allocation of electronic services for which any QoS information is unknown, (4) incentive compatibility: The mechanism has to provide adequate incentives to strategic individuals in order to ensure truthful bidding, (5) individual rationality: The participation decision in the mechanism must be voluntarily to all bidders, (6) budget balance: The mechanism must omit any independent intermediary in order to facilitate distributed decision-making among the participants, (7) optimality: The ultimate objective of the mechanism is to achieve an outcome that is optimal from a social welfare perspective. Standard impossibility theorems from mechanism design theory assert that meeting these requirements simultaneously is not attainable. In particular, ex post optimality cannot be attained when incentive compatibility, individual rationality, and budget balance are required as well. Therefore, the mechanism designer must decide about a viable tradeoff of these requirements. One possible compromise in the presence of privately known QoS is to derive a second-best mechanism that satisfies incentive compatibility, individual rationality, and budget balance. The outcome of such second-best mechanisms can be used to estimate the efficiency loss that must be tolerated in comparison to the first-best outcome. The objectives of this research are to (1) develop a second-best mechanism for allocating electronic services with private quality information and (2) study its efficiency properties in a set of simulation experiments to demonstrate its usefulness. All experiments imply that the asymptotic efficiency of the second-best mechanism is bounded away from 100% even for large markets. This finding is related to the economic concept of informational smallness, which is defined as the incremental impact of an participants QoS on the demand of an electronic service. In the proposed model, each provider offers a service of distinct QoS, and each customer demands a service of distinct QoS. It is this feature of differentiated service quality that prevents the participants from becoming informationally small as the market becomes large. If each participant’s private information about QoS follows the uniform distribution, the mechanism must tolerate an efficiency loss of more than 31% for an increasing number of customers and providers. In contrast, if private quality information is normally distributed among participants, this research finds that the mechanisms asymptotic inefficiency can be reduced to about 7% as the market size increases on both sides. With asymmetric, beta-distributed QoS, the mechanism arrives at an asymptotic efficiency of more than 91%. These findings are crucial to social planners because in designing service allocation with double-sided competition, they can obtain an accurate estimation of potential efficiency losses that arise from asymmetric information about QoS. On the other hand, the social planner can ensure that every allocation decision is made by the participants only. Hence, the emerging mechanism implementation eludes the need for an external, independent decision maker.
Essays in health economics
(2018) Kaiser, Micha; Sousa-Poza, Alfonso
In economic theory a lot of attention is given to the understanding and modelling of consumption decisions of individuals. Usually, most models assume that individuals consume different markets goods and maximize their utility with respect to certain constraints. These constraints can be of various kinds. Besides monetary constraints health related constraints are vitally important during the maximization process of individuals. In such a paradigm, individuals would therefore benefit indirectly from being in a good health state, since this would imply that they are less constrained and could therefore shift their individual utility to a higher level. Moreover, health can also be treated as a good itself. Such an approach would assign a direct effect of different health states to an individuals utility rather than incorporating health states by including them as a source for binding constraints. Apart from the different strategies in modelling the consumption decisions, both ways of thinking have in common that the achievement as well as the maintenance of a good health state is – to some extent - a necessary condition to foster the utility maximization process. Additionally, health outcomes of individuals are highly sensitive to economic circumstances and different policy interventions. For instance, a change in the individuals income will lead to an adjustment of the optimal consumption decision and therefore also to an adjustment of the health outcome (either in a direct or indirect way). Therefore a profound understanding of the impact of changes in economic and political processes helps to assess their effects on the health outcomes of individuals. Hence, this thesis investigates the impact of different economic factors and policy interventions on health. In particular, the thesis contributes to the literature in the following way: Chapter two uses 22 years of data from the German Socio-Economic Panel and information on plant closures to investigate the effects of unemployment on four indicators of unhealthy lifestyles: diet, alcohol consumption, smoking, and (a lack of) physical activity. The main goal is to assess possible causal effects of unemployment on risky behaviors. In fact, in contrast to much of the existing literature the empirical identification strategy used in this analysis, is able to clearly identify exogenous effect and therefore avoids endogeneity, which may result from reversed causality. The main results provide little evidence that unemployment gives rise to unhealthy lifestyles. Chapter three evaluates the relation between preschool care and the well-being of children and adolescents in Germany by using data from the German Health Interview and Examination Survey of Children and Adolescents. Analyzing this relationship is important to provide conclusive knowledge for parents as well as policy-makers due to several reasons. While parents are interested in providing the best health outcomes for their children, policy-makers need to balance a possible trade-off between economic as well as social costs and benefits related to preschool care. Additionally, the chapter examines differences in outcomes based on child socioeconomic background by focusing on the heterogeneous effects for migrant children. The findings suggest that children who have experienced child care have a slightly lower well-being overall. For migrant children, however, the outcomes indicate a positive relation. The fourth chapter analyzes how a nationwide population-based skin cancer screening program (SCS) implemented in Germany in 2008 has impacted the number of hospital discharges following malignant skin neoplasm diagnosis and the malignant melanoma mortality rate per 100,000 inhabitants. Therefore, panel data from the Eurostat database, which covers subregions in 22 European countries is analyzed for the years 2000-2013. By using fixed-effects methods, the causal relationship between the skin cancer screening program and the change in diagnosis and mortality rates are identified and a policy implication is derived. While the results indicate that Germany’s nationwide SCS program is effective in terms of a higher diagnosis rate for malignant skin neoplasms and thus may contribute to an improvement in the early detection of skin cancer, there is no significant influence on the melanoma mortality rate. Chapter five analyzes how closely different income measures conform to Benford’s law, a mathematical predictor of probable first digit distribution across many sets of numbers. Because Benford’s law can be used to test data set reliability, a Benford analysis is applied to assess the quality of six widely used health related survey data sets. This is of particularly importance for health economists, since the majority of empirical work in this field relies on information from survey data. The findings indicate that although income generally obeys Benford’s law, almost all the data sets show substantial discrepancies from it, which can be interpreted as a strong indicator of reliability issues in the survey data. This result is confirmed by a simulation, which demonstrates that household level income data do not manifest the same poor performance as individual level data. This finding implies that researchers should focus on household level characteristics whenever possible to reduce observation errors.
Essays on long-term care and health insurance
(2018) Schreckenberger, Christopher Karl Ludwig; Schiller, Jörg
This thesis contributes to the literature on the impact of two individual options that may help to alleviate the financial pressure on the public sector with respect to health and long-term care expenditures. A particular focus is on the German health insurance and long-term care insurance (LTCI) system. The first option refers to the shifting of LTCI and health insurance coverage from a public system to markets for voluntary private health insurance (VPHI) and private LTCI. These private insurance markets may suffer from inefficiencies due to asymmetric information and selection effects, such as adverse selection. Hence, three papers in this thesis analyze selection effects in markets for VPHI and private LTCI. The first paper (chapter 2) reviews the empirical work on asymmetric information and related selection effects in markets for private LTCI and in the U.S. market for Medigap insurance. After providing an overview of the existence of selection effects in these markets, the review examines the evidence on several potential sources of selection. Regarding the latter, a focus is on the role of private information that individuals have on their risk type, on the role of the individual’s risk preferences and of sociodemographic characteristics. Following the review, two empirical papers analyze selection effects in the German markets for complementary private LTCI (chapter 3) and for supplemental dental insurance (chapter 4). Both markets have in common that they provide voluntary private insurance coverage for residual out-of-pocket expenditure risks not covered by statutory LTCI or health insurance in Germany. In addition, the ex-ante premium differentiation is rather limited in these markets. This makes these markets prone to selection effects. Using a large dataset on more than 98,000 individuals from a German private insurance company, the findings in chapter 3 suggest that advantageous selection is the dominating type of selection in the German market for complementary private LTCI. Examining potential drivers for selection, the analysis indicates that the occupation as well as the residential location are observable characteristics that are not used for pricing, but that contribute to advantageous selection through the socioeconomic status. The holding of supplemental health insurance policies is another observable attribute that affects the selection behavior. Analyzing the selection behavior within a dynamic framework, the analysis shows that the uptake and the cancellation of LTCI policies are associated with changes in health insurance payouts. Moreover, individuals with financial problems and with a lower socioeconomic status are more likely to drop complementary LTCI coverage. Based on survey data from the Healthcare Monitor of the Bertelsmann Stiftung, the findings in chapter 4 do not reveal a significant correlation between insurance coverage and risk in the market for supplemental dental insurance in Germany. Since one possible explanation for this finding is heterogeneous selection leading to an offsetting of adverse and advantageous selection, a large set of potential sources of selection effects is tested. The results indicate that the holding of other supplemental health insurance policies is a main driver for advantageous selection in this market. The findings in this chapter provide solid evidence that this insurance market suffers from asymmetric information and selection effects even though the correlation between insurance coverage and risk is not statistically significant. Instead of shifting insurance coverage to a private insurance system, another option to alleviate the financial burden in a public health insurance system, which is analyzed in this thesis, refers to the promotion of preventive health care. Specifically, the fourth paper (chapter 5) empirically examines the effectiveness of a nationwide population-based skin cancer screening (SCS) program that was implemented in Germany in 2008. To this end, panel data from 2000 to 2013 of the Eurostat database on subregions in 22 European countries are exploited. Using fixed effects methods, the results show a positive and robust effect of the German SCS program on the diagnosis rate for malignant skin neoplasms, but no significant impact on the melanoma mortality rate. The former suggests that this program is effective in terms of an increased diagnosis rate for malignant skin neoplasms and may therefore contribute to an improved detection of skin cancer at an early stage.
Essays on remuneration systems of financial advisors
(2019) Weinert, Markus; Schiller, Jörg
Various policy interventions aim at preventing consumers from inadequate financial advice. One important issue that is often subject to intense discussions is the regulation of financial advisors compensation. In most countries, financial advisors are remunerated by product providers via commissions. Concerns are, that this practice leads to biased advice, since an advisor then has an incentive to recommend the product with the highest commission instead of the most suitable product. In order to circumvent the aforementioned incentive problems, consumer protection agencies and regulators propose that financial advisors should exclusively be compensated by consumers via a fee-for-advice. Even though, enacting a ban on commissions constitutes a severe intervention for financial advice markets, the effects of such a regulatory measure are only inadequate studied. The aim of this dissertation is to derive a deeper understanding of how a ban on commissions affects these markets. The three essays in the present thesis analyze the effects of a ban on commissions on bias in advice, total welfare and competition between product providers. The first essay considers the effect of a ban on commissions on the bias of advice in a theoretical model. If consumers ask for reasons and explanations in the advice process, why a particular product should suit their needs, an advisor faces transaction costs for recommending a product. These “persuasion costs” are intuitively low for a product, which is initially preferred by consumers (standard product), and high for a product, which is in consumers eyes unlikely to satisfy their needs (specialized product). The theoretical model shows that advice might not be solely distorted by commissions, but also by these persuasion costs. Therefore, advice can also be biased when consumers exclusively compensate the advisor. The extent of biased advice depends crucially on market shares of product providers and on potential reputational costs for the advisor enforced by market discipline. The second essay theoretically analyzes welfare effects of fee-based and commission-based remuneration systems for financial advisors. In markets, where advice is essential for consumers, product providers usually cannot sell their products directly to consumers. In these markets, commissions do not only serve as a compensation for the advisor, but also as a channel for competition between product providers. Consequently, a regulatory ban on commissions should be considered as a two-sided coin. On the one hand, a ban on commissions may reduce distortion in advice, but on the other hand, it may restrict competition between product providers. The analysis shows, that product providers have different incentives to compete through commissions depending on their market shares, consumers product valuation and potential reputational costs for the advisor. If the difference of commissions for different products is sufficiently small in equilibrium, a commission-based remuneration system leads to a strictly higher total welfare in comparison to a fee-based remuneration system due to a higher fraction of consumers, who are matched with their best suitable product. Otherwise, total welfare is higher under a fee-based remuneration system. The third essay theoretically analyzes whether and how product providers are able to compete in markets where products cannot be sold directly to consumers and commissions are banned by regulation. In particular, two possible channels are considered: Competition through product prices and competition through informative advertising. If a product provider engages in informative advertising, consumers may already be familiar with certain product characteristics before consulting an advisor. By this, advisors persuasion costs for the advertised product may be lower in an advice process, which results in a higher incentive to recommend the advertised product in comparison to other products. In addition, product providers are able to steer advice towards an advertised product. It is shown, that competition through product prices does not take place in equilibrium. However, informative advertising may serve as a channel for competition between product providers if the effect of steering advice is sufficiently high. Analogous to commissions, product providers incentives to engage in informative advertising depend on market shares, consumers product valuations and potential reputational costs for the advisor. In summary, this thesis provides detailed insides of an advice process and the affiliated interaction of driving factors, which influence the quality of advice. The underlying analysis shows that a fee-based remuneration system for financial advisors does not constitute a universal remedy for biased advice and total welfare losses in the corresponding markets.
Flexibilisierung synchronisationsdefekter Beschaffungsketten : Entwurf eines fachkonzeptuellen Datenmodells für Logistik-Anwendungssysteme am Beispiel mechatronischer Produkte in der Automobilwirtschaft
(2014) Weiss, Daniel; Kirn, Stefan
The thesis investigates supply chains of mechatronic products in the automotive industry. In the past supply chains often were considered as stable, intercompany relations with long-running general agreements, predefined services and service flows. Due to the differentiation of demand in the form of complex mechatronic products, those stable relations, nowadays, are increasingly fading. From a customer’s point of view “mechatronic supply chains” result in increasing information acquisition costs, as procurement decision alternatives along mechatronic supply chains are often defective (e.g. inadequately assessable). This loss of control during the procurement process occurs due to the fact that mechatronic products as well as their components and parts show a high level of variety, different technologies and divergent life cycle stages. With regard to an entire mechatronic supply chain, the thesis describes this observation as a synchronization defect. Since the specific attributes of mechatronic supply chains do not allow the use of standard synchronization methods, the thesis aims to flexibilize the supply chain by means of IT application systems. Therefore, in particular, the thesis designs a conceptual data model which reduces information acquisition costs during the procurement initiation and processing along mechatronic supply chains, opening up shorter reaction times and/or additional options for action. Conceptual data models describe business problems from an IT application systems’ point of view. The design of a new data model is required due to the fact that the investigated conceptual data models showed only a small benefit related to the problem. The investigated models often were too unspecific and/or designed for other purposes (e.g. other tasks, industries).
Fuel for life : domestic cooking fuels and women’s health in rural China?
(2016) Xue, Jianhong; Sousa-Poza, Alfonso; Nie, Peng
Using longitudinal and biomarker data from the China Family Panel Studies and the China Health and Nutrition Survey, this study examines the association between the type of domestic cooking fuel and the health of women aged ≥16 in rural China. Regarding three major domestic cooking fuels (wood/straw, coal and liquefied natural gas (LNG)), we find that, compared to women whose households cook with dirty fuels like wood/straw, women whose households cook with cleaner fuels like LNG have a significantly lower probability of chronic or acute diseases and are more likely to report better health. Even after controlling for unobserved individual heterogeneity, we find some evidence that women in households cooking with LNG are less likely to suffer from chronic/acute diseases. Cooking with domestic coal instead of wood or straw is also associated with elevated levels of having certain risks (such as systolic and diastolic blood pressure) related to cardiovascular diseases.
How does subjective well-being evolve with age? A literature review
(2013) Sousa-Poza, Alfonso; Moeller, Valerie; López Ulloa, Beatriz Fabiola
This literature review provides an overview of the theoretical and empirical research in several disciplines on the relation between ageing and subjective well-being, i.e., how subjective well-being evolves across the lifespan. Because of the different methodologies, data sets and samples used, comparison among disciplines and studies is difficult. However, extant studies do show either a U-shaped, inverted U-shaped or linear relation between ageing and subjective well-being.
Incentives in health care provision
(2022) Weinert, Johanna Katharina; Schiller, Jörg
The importance of finding ways to ensure high quality health care provision in a cost-effective and efficient way becomes a more and more pressing issue considering the challenges many economies currently face due to ageing populations, rising costs caused by advancements in medical technology or an increasing shortage in qualified personnel. Chapter 2 analyzes empirically how the introduction of a surgical suite governance document affects punctuality in first case of the day starts. Delays in first cases are an indicator for inefficiencies in operating room utilization. Because operating rooms constitute a major driver in hospitals’ operating costs, clinic management has a strong interest in incentivizing process efficiency. This analysis focuses on the implementation of a surgical suite governance document, which explicitly specifies the starting time of the first case of the day and formulates scheduling rules. First case punctuality is an easily observable and measurable performance indicator, which is associated with only minor tracking efforts and consequently low costs. The analysis uses a quasi-experimental setting, which arose from the lagged implementation of an identical governance document in two different hospital sites belonging to the same hospital group. To assess the effect of the governance document empirically , a difference-in-difference estimation approach is implemented. Results indicate that the introduction of a surgical suite governance document is associated with significant reductions in first case delays. In conclusion, a surgical suite governance document seems to offer a promising tool to incentivize health care workers to use costly resources like surgery capacities more efficiently. Chapter 3 analyzes the effects of a reimbursement change - from fee-for-service paid out-of-pocket (OOP-FFS) to a capitation fee per patient - on health service provision. This change was part of a selective contract in outpatient pediatric care introduced by a large German sickness fund in 2014. The present analysis aims at deriving further insights on how reimbursement affects service provision and at offering guidelines for future designs of selective contracts. To reflect the special features of the analyzed selective contract, namely that incentives change for both the pediatricians and the patients simultaneously, a theoretical model is set up to derive a testable hypothesis. The model predicts that given pediatricians are not only monetarily incentivized (but also sufficiently concerned about patients’ well-being) and that costs associated with screening provision are relatively small, reimbursement change from OOP-FFS to capitation will induce an increase in service provision. Using a generalized difference-in-difference approach, the theoretically derived hypothesis is tested empirically. Results indicate that the change from fee-for-service paid out-of-pocket to a capitation fee per patient did lead to a significant increase in provided screenings as the number of diagnoses more than doubles for pediatricians enrolled in the program. These findings indicate that physicians are not solely driven by monetary incentives and that capitation per patient offers a valuable tool to ensure cost control yet simultaneously ensure effective health care provision. Chapter 4 examines to which extent policymakers are able to incentivize hospitals to increase quality provision by actively fostering the link between performance indicator reporting and hospitals’ reputation. A better understanding of policymakers influence on quality incentives is crucial as empirical findings show that hospitals vary with respect to quality provision, implying that potential for improvements exists at least for some service providers. By fostering the link between hospitals’ outcome-based performance indicators such as mortality-, readmission- or complication rates and reputation, policymakers are able to affect hospitals’ market share and thereby ultimately hospitals’ incentives for quality provision. Ways to strengthen the aforementioned link are manifold, e.g. by raising awareness about the existence and importance of hospital performance reports or by improving populations’ health literacy to ensure that patients are able to decode the information provided by performance indicators correctly. The main finding is that a strengthened link between performance indicators’ realization and hospitals’ reputation does not necessarily result in stronger incentives for quality provision. In the case where the degree of competition is sufficiently low and the costs associated with quality provision are sufficiently high, an intensified link between performance indicators and reputation induces a decrease in quality provision. If the opposite is true, strengthening the link between performance indicators’ realization and hospitals’ reputation always induces an increase in quality provision.
Interdependenzen zwischen Planungsproblemen : ein multiagentenbasierter Koordinationsansatz
(2016) Schüle, Michael; Kirn, Stefan
In this thesis, interdependencies of planning problems in a supply chain in the context of a civil engineering logistic scenario are analysed. In this construction site scenario there are - within the scheduling of activities - the resource-constrained project scheduling problem (RCPSP) and - within the spatial distribution of activities - the asymmetric traveling salesman problem (ATSP) in an interdependence. The required coordination in order to resolve the impact caused by interdependencies of several planning is address as the core problem in this work. Since the individual planning processes do not consider the optimality of the planning of the respective other planning problem, there arise potentially in terms of the overall system and its objective function from the optimum material deviated solutions, although the isolated solutions of partial problems are optimally possibly. The coordination problem is exacerbated by the asymmetric distribution of information through the supply chain. From the perspective of the supply chain, this has the consequence that the service providers must be closely integrated as autonomous actors throughout all levels of the supply chain. In this context of the contractual relationship between the service providers with potentially different interests the coordination problem is extended to the coordination effort between the potentially autonomous providers. This decentralized decision situation must therefore be considered in the coordination of planning. Thereby software agents provide a suitable approach to represent autonomous, distributed, decentralized logistics systems. Especially the field of agent-based decentralized coordination for decentralized planning of decentralized plans offers this work a perspective to develop an approach for the coordination problem. Specifically, the agent-based coordination approach of the generalized partial global planning (GPGP) is used for the planning and coordination tasks, in which both the process of planning as well as the result of planning is distributed. Based on this method, a coordination approach along the interaction protocol engineering process model is developed. The result represents a coordination protocol. The evaluation is performed using the method of simulation as part of a multi-agent simulation. The simulation model is a reduced version of the construction site scenario. The aim of the simulation is to show that the presented multi-agent system and developed coordination protocol (1) are suitable for the optimization of the interdependent planning problems and (2) showing a sound system behaviour.
Internet use and subjective well-being in China
(2015) Sousa-Poza, Alfonso; Nimrod, Galit; Nie, Peng
Using data from the 2010 China Family Panel Studies, we analyze the association between Internet use and various measures of subjective well-being (SWB) in a sample of 16- to 60- year-old Chinese. Our analysis shows that although intensive Internet use is significantly associated with lower levels of SWB, we hardly observe any associations when the focus is on participation in specific online activities. Nevertheless, SWB depends on perceptions of Internet use; that is, the importance that different individuals ascribe to different purposes for using the Internet and how much they believe that their Internet use is displacing other activities. Our results suggest that, contrary to previous findings, differences in beneficial outcomes (the third level digital divide) do not necessarily arise from individuals’ actual Internet use (the second level digital divide) but rather may result from their subjective perceptions of such usage. Our findings also point to a possible cultural factor that puts Chinese Internet users at psychological risk.
Investor sentiment in blogs : design of a classifier and validation by a portfolio simulation
(2016) Klein, Achim; Kirn, Stefan
How can investment recommendations available on the web significantly improve stock selection? This dissertation shows how online investment recommendations can automatically be analyzed, aggregated, and used to achieve a return above the market’s. To this respect, it is crucial to understand how investment recommendations affect returns. Therefore, the dissertation examines the effects of direct and indirect investment recommendations from blogs in the form of investor sentiments (i.e., opinions) on the expected development of stock prices. Blogs have made it possible for everyone to publish articles on the web. The studied blog platforms Seekingalpha and Blogspot host a wealth of semi-professional stock analyses, investor opinions, company rumors, and stock recommendations. The dissertation’s study uses about 77,000 articles from Seekingalpha and about 198,000 articles from Blogspot over a five-year period (2007-2011). A novel text classification method is developed for the automatic classification of blog articles in a positive vs. negative sentiment. To achieve a high classification accuracy, experiments were carried out to configure this method. The text classification method uses machine learning techniques, which learn from manually classified articles from a novel corpus. Using behavioral finance theory, hypotheses are developed about the effects of investor sentiments on a portfolios returns. To test these hypotheses, a monthly selection of stocks of the Dow Jones Industrial Average into a portfolio was simulated (i.e., backtested). The selection is made by means of the ranking of the monthly aggregated overall sentiment of all articles regarding a specific stock. The results show that a return above the market’s can be achieved with aggregated investor sentiments from the Seekingalpha platform. In most cases, the achieved return exceeds the return of a momentum portfolio based solely on past returns. For the platform Blogspot, results are weaker. Overall, it seems advisable for investors to select a small number of stocks based on the most positive and most negative monthly investor sentiments from professional blogs.
Job insecurity, employability, and health : an analysis for germany across generations
(2014) Otterbach, Steffen; Sousa-Poza, Alfonso
In this paper, we use 12 waves of the German Socio-Economic Panel to examine the relationship between job insecurity, employability and health-related well-being. Our results indicate that being unemployed has a strong negative effect on life satisfaction and health. They also, however, highlight the fact that this effect is most prominent among individuals over the age of 40. A second observation is that job insecurity is also associated with lower levels of life satisfaction and health, and this association is quite strong. This negative effect of job insecurity is, in many cases, exacerbated by poor employability.
Management von Cyber-Risiken und Möglichkeiten des Risikotransfers : eine ökonomische und versicherungstechnische Analyse
(2016) Haas, Andreas; Schiller, Jörg
In a data-based economy cyber-risks are an emerging operational risk. Data breaches, data destruction or business interruption resulting from a cyber attack, can lead to unexpectedly high costs. The increasing exposure of companies to cyber risks is the consequence of a lasting change in the digital economy. At the same time, continuous investments in technological prevention measures to reduce the cyber-damage risk may come to an economic limitation. With the growing use of cloud services in businesses, the cyber-risk exposure increases, especially when sensitive digital information is processed. The problem with cyber-risks regarding cloud services is that the possibilities of technological IT risk management are limited. Moreover, the financial consequences of a cyber attack may exceed the risk-bearing capacity of the affected company. Therefore, risk transfer instruments such as cyber-insurance can reduce the financial risk of cyber attacks. But despite an increased use of cloud services and a significantly rising number of cyber attacks, the cyber insurance market in Germany remains at a very low level. The aim of this work is the economic analysis of the management of cyber risks. For this purpose, cyber risks are explained in detail, and a market analysis of existing cyber insurance concepts in Germany is conducted. We find explanations for the low demand for cyber insurance products in Germany: Especially existing gaps in current coverage are identified as a market barrier. To improve cyber insurance coverage, technological development, and changes should be anticipated and implemented faster into the coverage of cyber insurance products. We developed new approaches to identify and analyze new technological risks in the context of emerging technologies like Cloud-Computing and the Internet of Things. Based on that analysis we highlight the importance of an insurance-based risk transfer. As we identify incentives for companies to externalize the costs of cyber attacks, we discuss regulatory measures to increase the general risk perception in the market to avoid such behavior. With the internalization of the financial consequences of cyber-attacks, the relevance of cyber-insurance as a complementary element in risk management increases.

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