Institut für Health Care & Public Management

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

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Associations between individual factors, environmental factors, and outdoor independence in older adults
(2020) Schehl, Barbara; Leukel, Jörg
The degree to which individuals can accomplish outdoor activity by themselves or require support is an important facet of successful aging. While prior research focuses on participation in outdoor activity, understanding of older adults’ outdoor independence is limited. We adopt an ecological approach to examine the role of individual factors and environmental factors in explaining outdoor independence. Our sample comprised older adults aged 65 + living in a medium-sized city in Germany (N = 1070). The results show that being male, younger, and healthier was positively associated with outdoor independence, while living together was not. Further, outdoor independence decreased with higher levels of perceived environmental barriers. This negative association was moderated such that it was stronger for the less healthy and older participants. Based on our empirical findings, we offer insights for policy makers, urban planners, and community groups to design age-friendly communities and consequently facilitate outdoor independence among older adults.
The effect of SMS nudges on higher education performance
(2024) Brandt, Alicia; Oskorouchi, Hamid R.; Sousa-Poza, Alfonso
Driven by higher education’s challenges in maintaining student motivation and achievement during the recent pandemic-induced shift to online learning, we investigate the effectiveness of text messages as a nudging tool to increase academic performance. To do so, we use a nonplacebo randomized controlled trial in which the treatment group directly receives SMS texts that review lecture content and give deadline reminders, while the control group only has access to the same information on the course page. Our findings suggest that the reception of motivating SMS messages per se, rather than the content review, has a positive effect on examination outcomes.
Embracing digital health: German otolaryngology patients’ usage and prospects of digital information and communication technologies for cross-sectoral care
(2024) Holderried, Martin; Hoeper, Ansgar; Stauss, Leonie; Holderried, Friederike; Herrmann-Werner, Anne; Kestler, Hans A.; Ernst, Christian; Baerhold, Friederike; Becker, Sven
Objective: The usage of digital information and communication technologies in European healthcare is growing. Unlike numerous technological possibilities, the present use of these technologies and perspectives towards them in relation to otolaryngology care have so far been of less interest. This study evaluates the utilisation of and attitudes towards digital information and communication technologies in cross-sectoral otolaryngology care among German patients. Methods: A structured interview-based study was conducted at the outpatient facility of a tertiary hospital in Germany. It focused on chief complaints, current use of digital technologies, estimated benefits of increased digital technology use in otolaryngology care, and sociodemographic data. The detailed statistical analysis employed Chi-squared tests and multivariate logistic regression. Results: A total of 208 otolaryngology patients completed the interview. Digital communication technologies exhibited a high penetration rate (91.8%) and were regularly used in daily life (78.7%) and for health reasons (73.3%). Younger age ( p ≤ 0.003) and higher education levels ( p ≤ 0.008) were significantly correlated with the increased digital communication technology use. The overall potential of eHealth technologies was rated significantly higher by younger patients ( p ≤ 0.001). The patients’ chief complaints showed no significant influence on the current and potential use of these technologies for cross-sectoral otolaryngology care. Conclusion: Regardless of their chief complaints, German otolaryngology patients regularly use digital information and communication technologies for health reasons and express interest in their further use for cross-sectoral care. To enhance digital patient communication in otolaryngology, attention should be given to treatment quality, usability, data security and availability and financial remuneration for service providers.
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.
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.
The long-term cognitive and schooling effects of childhood vaccinations in China
(2024) Oskorouchi, Hamid R.; Sousa-Poza, Alfonso; Bloom, David E.
By exploiting rich retrospective data from the China Health and Retirement Longitudinal Study on childhood immunization, socioeconomics, and health status, we assess the long-term effects of childhood vaccination on cognitive and educational outcomes in China. Applying an instrumental variable approach that resembles an unobserved natural experiment to different sets of control variables and subsamples, we estimate the average and local treatment effects of childhood vaccination. Our results confirm that immunization before the age of 15 has long-term positive and economically meaningful effects on non-health outcomes such as education and cognitive skills. These effects are strong, with vaccinated individuals enjoying about one additional year of schooling and performing better on several cognitive tests later in life. Finally, a causal mediation analysis shows that, although education mediates the effect of childhood immunization on later-life cognitive abilities, other factors (e.g., better child health) are more responsible for these long-term effects.
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 burnout among healthcare professionals: Insights from the pandemic and implications for future public health crises
(2025) Daneshvar, Elahe; Otterbach, Steffen
This study evaluates the prevalence of burnout among healthcare professionals (HCPs) during the COVID-19 pandemic in Iran and examines its association with key occupational stressors (workload, job control, and leadership communication). Furthermore, it proposes relevant organisational interventions for future pandemic preparedness. A cross-sectional survey of HCPs (N = 723) was conducted in four hospitals in Tehran during the third peak of the COVID-19 pandemic in Iran, including the Copenhagen Burnout Inventory and items on perceived workload, job control, and leadership communication. The study found that 67.41% of HCPs reported substantial symptoms of burnout (moderate-to-high burnout, i.e. CBI ≥ 50), with a mean score of 59.6 points. The prevalence of burnout (CBI ≥ 50) was prominent across all three dimensions—personal, work, and patient-related—at 72.86%, 69.87%, and 65.37%, respectively. The analysis demonstrated significant associations between burnout and the three foundational workplace stressors. Multivariate linear regression analysis showed that frontline, female, and married HCPs reported the highest levels of burnout. This study provides practical implications for healthcare organisations and policy makers, highlighting the need for targeted organizational interventions that could mitigate burnout during ongoing and future health crises.

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