Institut für Health Care & Public Management

Permanent URI for this collectionhttps://hohpublica.uni-hohenheim.de/handle/123456789/25

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Gambling operators’ use of advertising strategies on social media and their effects: a systematic review
(2024) Singer, Johannes; Wöhr, Andrea; Otterbach, Steffen
Purpose of Review: Social media offer gambling operators an attractive channel for connecting with gamblers and promoting their products. The aim of the present study is to review the recent literature to summarise the latest findings on marketing strategies of gambling operators, and their effects, with particular focus on social media. Recent Findings: A systematic review on gambling advertising in social media has been conducted, taking into account English-language journal articles from 2021 onwards, which include primary data collection. Searching three data bases, a total number of 12 studies from peer-reviewed journals were identified. Gambling advertising has an enormous reach, including esports sponsorship and a surge in popularity on streaming platforms, which raises concerns about the protection of gamblers in general and of vulnerable groups in particular. The studies identify individual advertising strategies and investigate the influence of incentives and tips on gambling behaviour. Gaps in the current literature include evidence from certain regions or countries, research into communication strategies on individual social media platforms, and questions about the effectiveness of regulatory measures regarding gambling advertising. Summary: Gambling operators flexibly adapt their advertising strategies to the surrounding conditions. This appears to be problematic, as the intensity and complexity of gambling advertising increases at the same time as the boundaries between advertising and seemingly neutral content blur. Vulnerable groups, especially children and adolescents, are at special risk, because advertising on social media is particularly attractive for them, while protection mechanisms such as age limits are often missing or being ignored.
Heterogeneous impact of social integration on the health of rural-to-urban migrants in China
(2022) Lu, Haiyang; Kandilov, Ivan T.; Nie, Peng
Background: While several studies have found that lower levels of social integration may lead to a deterioration in the health status of migrants, previous research on the nexus between social integration and health has generally ignored the potential endogeneity of social integration. This paper examines the heterogeneous impact of social integration on the health of rural-to-urban migrants in China by exploiting plausibly exogenous, long-term, geographic variation in dialectal diversity. Methods: Drawing on nationally representative data from the 2017 China Migrants Dynamic Survey (n = 117,446), we first regressed self-reported health on social integration using ordinary least squares estimation and then used an ordered probit model as a robustness check. Additionally, to rule out the potential endogeneity of social integration, we relied mainly on an instrumental variable approach and used dialectal diversity as a source of exogenous variation for social integration. Results: We found that social integration has a significant positive impact on rural-to-urban migrants’ health. We also detected considerable heterogeneity in the effects of social integration across gender, generation, and wage levels: the health status of women, more recent generation migrants, and migrants with wages in the middle of wage distribution are more likely to be affected by social integration. Conclusions: We confirmed the beneficial impact of social integration on migrants’ health, which has some important policy implications. Successful migration policies should take the fundamental issue of migrants’ social integration into account.
How do gambling providers use the social network twitter in Germany? An explorative mixed-methods topic modeling approach
(2023) Singer, Johannes; Kufenko, Vadim; Wöhr, Andrea; Wuketich, Marius; Otterbach, Steffen
This study examines the social media activities of gambling providers in Germany, focusing on the platform Twitter. A collection of 34.151 tweets from 13 Twitter accounts was made, representing casinos, sports betting, state lotteries, social lotteries and lottery brokers. We apply an explorative mixed-methods approach, integrating a summative content analysis together with a semi-supervised guided topic modeling approach, to analyse frequency, number of followers, interaction and content of Twitter messages, and work out differences among the individual providers. The results show that Twitter does not seem to be particularly important for gambling providers who are active in Germany. Regarding outreach, frequency of tweets and interaction, Twitter plays a much smaller role than, for example, in the UK. The potential for Twitter to be an advertising, marketing and interaction channel has not yet been fully exploited, which would make it a perfect moment for developing an appropriate regulatory framework. Overall, the results of semi-supervised topic modeling show that providers most often use informative content ( news ) and combine it with other, usually less neutral content. It is alarming that many providers make little or no use of Responsible Gambling messages. Even though the activities are presently on a low level, they contribute to the normalization of gambling, setting incentives for increasing gambling participation. Children and youth form a large segment of Twitter users. Potential harm can arise especially for this group because of the lack of enforcement of any age limit.
The intangible costs of overweight and obesity in Germany
(2023) Meng, Fan; Nie, Peng; Sousa-Poza, Alfonso
Background: Previous literature documents the direct and indirect economic costs of obesity, yet none has attempted to quantify the intangible costs of obesity. This study focuses on quantifying the intangible costs of one unit body mass index (BMI) increase and being overweight and obese in Germany. Methods: By applying a life satisfaction-based compensation value analysis to 2002–2018 German Socio-Economic Panel Survey data for adults aged 18–65, the intangible costs of overweight and obesity are estimated. We apply individual income as a reference for estimating the value of the loss of subjective well-being due to overweight and obesity. Results: The intangible costs of overweight and obesity in 2018 amount to 42,450 and 13,853 euros, respectively. A one unit increase in BMI induced a 2553 euros annual well-being loss in the overweight and obese relative to those of normal weight. When extrapolated to the entire country, this figure represents approximately 4.3 billion euros, an intangible cost of obesity similar in magnitude to the direct and indirect costs documented in other studies for Germany. These losses, our analysis reveals, have remained remarkably stable since 2002. Conclusions: Our results underscore how existing research into obesity’s economic toll may underestimate its true costs, and they strongly imply that if obesity interventions took the intangible costs of obesity into account, the economic benefits would be considerably larger.
Lowering acquisition costs with a commission cap? Evidence from the German private health insurance market
(2023) Braegelmann, Kylie A.; Schiller, Jörg
When consumers are neither particularly financially literate nor price sensitive, insurers have a strong incentive to pay high commissions to intermediaries for profitable new business. As a part of cost reduction regulation in the German private substitutive health insurance market, a commission cap and a minimum cancelation liability period for insurance intermediaries were introduced in 2012. Despite the fact that the commission cap lowered commissions paid to intermediaries, we provide evidence that the reform was only partly effective, as it led to a decrease in reshuffling of new business in the substitutive market, but did not significantly reduce total acquisition costs of health insurers. Our findings confirm that cost regulation is tricky and can be easily circumvented by insurers, as commission payments are only a part of total acquisition costs.
The COVID-19 pandemic and emergencies in Otolaryngology-head and neck surgery: An analysis of patients presenting to emergency rooms in South-West Germany: A bi-center study
(2024) Wolpert, Stephan; Knoblich, Nora; Holderried, Martin; Becker, Sven; Schade-Mann, Thore; Mitra, Amal K.
This study was designed to examine the changes in emergency room visits in otolaryngology, head and neck surgery, during the COVID-19 pandemic. The study included 11,277 patients who presented to a tertiary care hospital (ER) and an emergency practice (EP) during on-call hours in the first half of 2018, 2019, and 2020. The epidemiologic parameters, diagnoses, and level of urgency were recorded using a four-step scale. A comparison was made between the pre-pandemic years and 2020. The findings revealed a significant decrease in the frequency of ER visits in the second quarter of 2020 compared to 2019 (ER: 30.8%, EP: 37.8%), mainly due to the fact that there were significantly fewer patients, with low levels of urgency. Certain diagnoses, such as epistaxis (−3.0%) and globus sensation (−3.2%), were made at similar frequencies to 2019, while inflammatory diseases like skin infections (−51.2%), tonsillitis (−55.6%), sinusitis (−59%), and otitis media (−70.4%) showed a significant reduction. The study concludes that patients with a low triage level were less likely to visit the ER during the early stages of the pandemic, but some diagnoses were still observed at comparable rates. This suggests a disparity in perception between patients and ER staff regarding urgency. Many of the issues discussed were also emphasized in the 2024 proposal by the German Ministry of Health to reform emergency care in Germany.
Workplace stressors and well-being of healthcare workers during the COVID-19 pandemic
(2025) Daneshvar, Elahe; Sousa-Poza, Alfonso
Health systems worldwide are facing a host of complex and multifaceted challenges, ranging from aging populations and patient safety to rapid evolution of therapeutic technologies and the need to sustain uninterrupted operations. Central to addressing these issues is the critical role of healthcare workers (HCWs) whose well-being is fundamental to the efficiency, resilience, and sustainability of healthcare delivery. The COVID-19 pandemic has brought these challenges to the forefront, exposing the vulnerabilities of health systems and reinforcing the urgent need to prioritize HCWs’ mental and physical health. This dissertation addresses this pressing concern through three scholarly papers, each exploring distinct dimensions of HCWs’ wellbeing during the COVID-19 pandemic: (I) sources of anxiety, (II) workplace stressors and burnout, and (III) global prevalence and risk factors for burnout. The relevance and sequencing of these three papers provide a comprehensive and cohesive understanding of anxiety and burnout as two pressing and growing concerns among HCWs, along with their contributing factors and actionable interventions. The first two studies investigate these phenomena within Iran—a context marked by resource constrains due to embargos—offering valuable insights into the local drivers of anxiety and burnout and their workplace-related stressors. This scope is expanded in the third paper through a systematic review of global research, providing a comparative understanding of burnout prevalence and risk factors across diverse healthcare settings. The first study investigates the sources of anxiety among HCWs in Iran, adapting the Stanford University School of Medicine’s classification framework. Surveying 723 HCWs, it confirms the relevance of the eight previously identified anxiety sources while revealing four additional stressors specific to the Iranian context: high workload, financial concerns, health risks (both physical and emotional), and inadequate leadership support. The findings highlight the disproportionate burden on women, nurses, and frontline workers, emphasizing the need for stronger organizational support and leadership engagement in resource-constrained healthcare settings. The second study examines workplace stressors and burnout among HCWs in Iran, finding a striking burnout prevalence of 67.41%. Using the Copenhagen Burnout Inventory and the components of the Job Demand-Control-Support model, it identifies excessive workload, limited job control, and poor leadership communication as key contributors to burnout. Frontline workers, married individuals, and women are particularly vulnerable. The study reframes burnout as a systematic issue rather than individual failing, underscoring the need for structural interventions such as workload redistribution, increased job autonomy, and improved communication strategies. It calls for leadership-driven initiatives to enhance HCWs’ resilience and prevent long-term workforce depletion. The third study extends this examination globally, systematically reviewing 64 studies from 16 countries to assess burnout prevalence and risk factors. Burnout rates frequently exceeded 50%, with frontline workers, nurses, and younger HCWs facing the highest risks. Common stressors included excessive job demands, insufficient resources including inadequate institutional support. The review also highlights sever health consequences linked to burnout, including stress, anxiety, depression, and physical ailments such as chronic headaches and sleep disturbance. Furthermore, burnout was closely associated with increased turnover intentions, threatening health system sustainability. Collectively, these studies identify critical gaps in existing organizational support structures, and provides actionable insights for addressing them. By integrating findings across diverse methodologies and contexts, the dissertation contributes to the growing body of literature on HCWs' well-being. The practical implications are clear: healthcare organizations and policymakers must adopt a proactive, comprehensive approach to support HCWs. This includes targeted interventions to alleviate foundational stressors, fostering supportive leadership, and strengthening organizational resilience to better prepare for future public health crises. By bridging the specific challenges of resource-limited settings with broader, universal trends, this dissertation highlights actionable pathways to enhance HCWs’ well-being and ensure the resilience of health systems in times of crisis. In doing so, it provides an evidence-based foundation for policymakers, healthcare leaders, and researchers to develop sustainable strategies that not only safeguard HCWs but also strengthen health systems, advance public health, and ultimately benefiting society as a whole.

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