Institut für Health Care & Public Management

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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).
Baseline assessment and cost analysis of a supplementary feeding intervention on Adivasi children in West Bengal, India
How to diversify diets with locally available resources cost-effectively to reduce the burden of child and maternal undernutrition and anaemia?
(2022) Golembiewski, Silvia; Sousa-Poza, Alfonso
This dissertation presented and analyzed the living, health and nutrition situation of tribal Adivasi children (aged 6-39 months) as well as of their mothers living in rural Birbhum district, West Bengal, India. It was found that extended families use to have higher incomes (p<0.05) compared to nuclear families and that higher education of mothers (having completed at least class eight) is associated with higher incomes, too (p<0.05). Higher incomes were further found associated with a lesser incidence of moderate and severe anaemia amongst children (p<0.05). Further, active child caring was found to decrease the incidence of stunting (p<0.05, for caring efforts of three hours or more per day) - while mothers tied up in cooking (with cooking efforts of 6 and more hours a day) showed to have bigger likelihood of having a wasted or underweight child (p<0.05). It was suggested that the provision of gas cookers along with cooking gas to Adivasi families may be helpful to free mothers to care more actively for their children and reduce therewith child undernutrition. The dissertation further revealed that either father or mother deciding alone how to expense available income is superior to joint spending decisions - and it was in fact HHs with mothers deciding alone which showed the largest share of children with no or merely mild anaemia (p<0.05). It was suggested, accordingly, that mothers may be entrusted to manage a food budget on their own. Very importantly, the nutritional status of children and their mothers was found to be linked, where mothers with adequate BMI (18.5 and higher) had less often than expected a wasted child (p<0.001) and also less often an underweight child (p=0.001). Severe thin mothers (with a BMI<16.0) showed biggest likelihood of having a child with at least one anthropometric failure. No significant association was found between the anaemia status of the mother and her youngest child (p>0.05). Still, non-anaemic mothers showed bigger likelihood of having non-anaemic children than mothers with poorer Hb statuses, and - the other way around - mothers with severe anaemia showed the biggest likelihood of having children with moderate anaemia. It was argued, accordingly, that not only children but also their mothers should be better nourished in order to break the vicious circle of undernutrition - with a focus on lactating mothers who have highest nutritional intake needs. Overall, 94 percent of tribal Adivasi children were found anaemic (n=307, age range: 6-39 months, Hb<11g/dl) as well as 86 percent of their mothers (n=283, Hb<12g/dl). Anaemia in children was found significantly associated with the age of the child (p<0.001) where Hb was found to rise with increasing age and children above three years reached mild forms of anaemia - while children aged 6-23 months commonly suffered from moderate anaemia. Further, the consumption of fruit was found to decrease the incidence of moderate and severe anaemia (p<0.05). There was also a link between child undernutrition and the occurrence of severe anaemia, where children with no anthropometric failure (CIAF indicator) showed lesser likelihood to develop severe anaemia compared to children with at least one anthropometric failure (p<0.05). Seeing the high incidence of anaemia and interlinking to child undernutrition as well as interlinking of nutritional status of children and their mothers - the question arose how to overcome child as well as maternal undernutrition and anaemia? The present comparative intervention study conducted in 21 tribal villages found that providing diversified meals three times a week to children aged 6-39 months rose their mean Hb by 0.98g/dl (compared to 0.45g/dl in the CG); it was found that after 12 months children receiving the diversified meals showed a bigger share of non-anaemic or only mildly anaemic children compared to the CG (p<0.05). Further, children who had received the diversified meals showed bigger likelihood of achieving Hb increases which belong to the top 30 percent of all reported Hb increases (amounting to 1.40g/dl and more) after 12 months of intervention compared to the CG (p<0.01). It was argued, accordingly, that providing nutritious meals to undernourished tribal Adivasi children increases Hb and reduces anaemia. No significant difference in the distribution of non-anaemic and mildly anaemic children versus moderately and severely anaemic children could be found when comparing a group of children who had received a leaf powder of Moringa and Amaranthus along with diversified meals to the CG (p>0.05) and when comparing a group of children who had received a (low dosed) micronutrient sprinkle along with diversified meals (p>0.05). A cost-effectiveness analysis of 425 locally available foods has been conducted in order to work out those foods delivering highest nutrient density in relation to their retail cost (adjusted for edible portion). Foods from the FGs cereals and millets, vegetables, and roots and tubers belonged more often to the top 30 percent of cost-effective foods as per winter-price analysis (p<0.001) - while also grain legumes became cost-effective as per summer-price analysis (p<0.05). While the overall cost-effectiveness of FGs showed little difference considering winter- and summer price analyses, the cost-effectiveness of specific foods within some of the analyzed FGs did actually change (especially in case of vegetables). It was recommended, accordingly, to use most cost-effective locally available foods to nourish undernourished children and mothers adequately - and to consider also seasonal price changes of foods thereby. The developed aggregate cost-effectiveness indicator covered 38 nutrients. Further, five anti-nutritive elements to be limited in the diet of undernourished individuals had been considered: oxalate, phytate, polyphenols, sodium as well as dietary fibre. The need to process foods rich in anti-nutrients in order to cover the RDAs of undernourished children and mothers was highlighted - working out a categorization of anti-nutritive elements in low (≤ 4th percentile), medium (> 4th until ≤ 8th percentile), high (>8th until ≤ 9.5th percentile) or very high (> 9.5th percentile) contents. On the basis of knowing most cost-effective locally available foods and assessing also their anti-nutritive elements, a weekly meal schedule has been worked out in cooperation with the nutritionist Caroline Stiller (who was the second PhD candidate in this twin PhD project and knows the local setting well). It became clear that the RDAs of moderately malnourished children and their mothers can hardly be fully covered with locally available foods alone - where a deficit of 20 and more percent of the RDA remained with regard to vitamins A, E, B1 and B2, as well as of zinc and linoleic acid (children), with regard to vitamins A, E, B1, B2 and B9, as well as of potassium and linoleic acid (lactating women), with regard to vitamins B1, B2 and B9, as well as of iron, potassium and linolenic acid (pregnant women), and with regard to vitamins B1 and B2, as well as of iron, potassium and linolenic acid (non-pregnant and non-lactating women). It was further found that the costs associated with the suggested cost-effective and nutrient-dense weekly meal schedule exceeded available family budgets (calculated based on n=66 HHs and with respect to consumed portion sizes of children and mothers) by 217 percent in case of children (with a weekly cost of 267 Rs. rather than the available 144 Rs.), and by 200 percent in case of lactating, pregnant as well as non-pregnant non-lactating mothers. The role of government services (AWCs, the PDS, and the MGNREGA), kitchen gardening/wild plant collection, own fishing activities and crop diversification in covering this deficit was enumerated and it was found that AWCs are able to cover the largest part of the weekly financing deficit (amounting to 34 percent in case of children), followed by kitchen gardens/wild plant collection (24 percent). As breastfeeding is deeply rooted in the Santal Adivasi communities (96 percent of mothers, n=275, were found to breastfeed their youngest child - with a mean age of 21.2 months), it is proposed in this dissertation that lactating women should be included as beneficiaries of AWCs in order to cover their nutrient needs and break - finally - the circle of undernutrition where children and mothers need to be seen together, rather than focusing merely on children in the well-known 1000-days window of opportunity.
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.
Digitale Transformation der Gesundheitsversorgung von Patienten mit Depression
(2024) Kittlick, Cornelia; Leukel, Jörg
Digitale Versorgungslösungen werden im deutschen Gesundheitssystem zunehmend eingesetzt, um die Patientenbehandlung effektiver und effizienter zu gestalten. Sie erleichtern Patienten mit Depressionen den Zugang zur Versorgung und können den Behandlungsprozess niederschwelliger gestalten. Krankenversicherungen, welche aufgrund der u.a. hohen ökonomischen Relevanz psychischer Erkrankungen vor großen wirtschaftlichen Herausforderungen stehen, benötigen nachhaltige Versorgungslösungen für ihre Versicherten. Hierzu gehören insbesondere hybride Versorgungslösungen, die Telefoncoaching mit Online-Kognitiver-Verhaltenstherapie kombinieren und i. d. R. von telemedizinischen Anbietern entwickelt werden. Zwar liegen bereits Untersuchungen zur Wirksamkeit und Kosteneffektivität von singulären Lösungen vor, allerdings ist noch ungeklärt, wie hybride Lösungen wirken, wie gesundheitsökonomisch sie sind und wie sie von der Zielgruppe akzeptiert werden. Erste Hinweise ergeben sich aus randomisierten kontrollierten Studien zu telefon-begleiteten Einzellösungen, jedoch mangelt es an empirischer Evidenz hinsichtlich der Wirksamkeit, Kosten und Akzeptanz von hybriden Ansätzen. Ziel der Dissertation war es, mittels einer kontrollierten Feldstudie die Wirksamkeit, Kosten und Akzeptanz einer hybriden gegenüber einer singulären Versorgungslösung zu unter-suchen. Die Studie wurde mit Versicherten einer privaten Krankenversicherung durchgeführt. Es wurden zwei Patientengruppen untersucht, welche sich für eine hybride (Interventionsgruppe IG, n = 207) oder eine singuläre Versorgungslösung (Kontrollgruppe KG, n = 102) entscheiden konnten. Für die Kostenanalyse wurde eine dritte Patientengruppe aus Nicht-Teilnehmern (n = 2.738) hinzugezogen, deren Kostendaten der IG und KG gegenübergestellt wurden. Die Wirksamkeit der Versorgungslösungen wurde mittels standardisierter Messinstrumente (Gesundheitsbezogene Lebensqualität: SF-36, Grad der Depression: PHQ-9) untersucht und definierte den individuellen Nutzen der jeweiligen Versorgungslösungen. Hierbei wurde die Hypothese untersucht, dass die hybride Versorgungslösung wirksamer ist als die singuläre. Die Wirtschaftlichkeit wurde durch eine Kosten-Effektivitäts-Analyse bewertet, um zu ermitteln, ob hybride Versorgungslösungen kosten-effektiver sind. Die Akzeptanzanalyse untersuchte Einflussfaktoren bei der Wahl der Versorgungslösung und identifizierte Merkmale der Zielgruppen, die sich für die hybride oder die singuläre Versorgungslösung entschieden. Hierbei wurden die Krankheitsschwere, die Versorgungssituation und die Internetaffinität als Einflussfaktoren vermutet. Die Ergebnis-se zeigen insgesamt, dass beide Versorgungslösungen wirksam und kosteneffektiv sind. Die Lebensqualität erhöhte sich im Durchschnitt über alle Subskalen (IG = 47,9 %; KG = 21,7 %). Ein Vergleich der Mittelwertdifferenzen zeigte statistische Effekte bei IG in den Subskalen VITA und SOFU mit jeweils schwachem Effektmaß. Die Analyse des Depressionsgrades wies ebenfalls statistische Unterschiede für IG und KG zwischen Baseline und Follow-up auf (IG: ΔM = –3,24; SD = 4,29; KG: ΔM = –2,78; SD = 5,66). Die Kostenanalyse zeigte, dass KG im Jahr vor Teilnahme die höchsten durchschnittlichen Gesamtbehandlungskosten aufwies (20.346 €), gefolgt von der IG (17.625 €) und der Gruppe der Nicht-Teilnehmer (16.928 €). Im Jahr der Teilnahme reduzierten sich die Kosten bei beiden Gruppen etwa im gleichen Maße (IG: –36,0 %; KG: –37,6 %). Die höchste Kostenreduktion zwischen dem Jahr vor und nach Teilnahme erfuhr KG (–46,1 %). Die Kosten-Effektivitäts-Analyse ergab, dass die IG sowohl höhere Nutzwerte als auch geringere durchschnittliche Gesamtkosten als KG aufwies. Bezüglich der Reduktion der Depressionsschwere zeigte sich, dass mit jeder Nutzwerteinheit Kosten in Höhe von 2.642 € (ICER = ¬2.642) und bei der gesundheitsbezogenen Lebensqualität zwischen 98 € und 330 € eingespart wurden. Somit zeigte die hybride gegenüber der singulären Versorgungslösung ein vorteilhafteres Kosten-Effektivitäts-Verhältnis. Die Akzeptanzanalyse ergab, dass die Krankheitsschwere sowie die Versorgungssituation wesentliche Einflussfaktoren auf die Wahl der Versorgungslösung waren. Patienten mit einer geringeren Krankheitsschwere und einer besseren Versorgung bevorzugten die hybride Versorgungslösung, während schwerer erkrankte Patienten mit einer schlechteren Versorgung die singuläre Lösung wählten. Die kontrollierte Feldstudie ermöglichte durch die multidimensionale Analyse von medizinischen Daten, Kostendaten sowie Akzeptanzbefragungen ein umfassenderes Verständnis zur digitalen Transformation der Versorgung von Patienten mit Depression. Sie schafft zusätzliche Evidenz zur Wirksamkeit, den Kosten und der Akzeptanz hybrider und singulärer Versorgungslösungen. Die Ergebnisse bieten neue Einsichten für Anbieter digitaler Versorgungslösungen, wie sie diese zielgruppengerecht entwickeln können. Krankenversicherungen dienen die Ergebnisse für eine bessere Entscheidungsfindung, wie sie digitale Versorgungslösungen nachhaltig einsetzen können, um Betroffenen zu helfen und gleichzeitig dem Ressourcenmangel im deutschen Gesundheitssystem entgegenzuwirken.
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 in health economics
(2023) Meng, Fan; Sousa-Poza, Alfonso
As the global economy and healthcare evolve, subjective well-being is increasingly becoming a topic of interest in the field of health economics. In this dissertation, we try to investigate subjective well-being from two related aspects: obesity and marriage. Obesity is a global health crisis that has reached alarming proportions in recent years. Defined as an excessive accumulation of body fat, obesity has far-reaching implications for both individ- ual health and society as a whole. Its prevalence has steadily risen, with over 650 million adults worldwide classified as obese, according to data from the World Health Organization (WHO). This epidemic has led to a surge in obesity-related health problems, including diabetes, cardio- vascular disease, and certain types of cancer, making it a pressing concern for healthcare systems and policymakers. Estimates of the cost of obesity are an important basis for the development and evaluation of obesity-related policies. Previous studies have estimated the direct and indirect costs of obesity, but in addition to these, the intangible costs of obesity are also noteworthy. The intangi- ble costs of obesity are associated with a loss of well-being. In addition, obesity-related inequality may also combine with peer effects to lead to lower well-being in obese individuals. So, ignoring the intangible costs of obesity may lead to underestimating the benefits of obesity control policies. Marriage, without a doubt, is a major event in life. People from almost any socio-cultural back- ground consider marriage-related decisions such as whether to get married, when to get married, and with whom to get married. But nowadays, in increasingly countries around the world, mar- riage rates continue to decline and the age of first marriage continues to be delayed, so we sought to analyze whether these trends are related to marriage-related well-being. The contributions of each chapter are shown below: Chapter 2 uses SOEP 2002-2018 data and a life satisfaction-based compensation approach to quantify the intangible costs of overweight and obesity. 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. 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. Chapter 3 uses data from the German Socio-Economic Panel (GSOEP), investigates the changes in the BMI distribution and obesity inequality among German adults aged 18+ between 2002-2018 and estimates the relationship between obesity inequality and subjective well-being. The results show that the rise in obesity prevalence is mainly due to an overall rightward shift of the BMI distribution, accompanied by an increase in left skewness. Over the entire 16-year period, obe- sity inequality increased significantly, especially among females, those with low education levels, and low-income groups. The results also document a significant association between different measures of obesity inequality and subjective well-being, especially among women. Chapter 4 explores the trends in the subjective well-being (SWB) of never-married people (referenced with the married) and the factors that account for the gaps in SWB between never- married and married people. By employing a harmonized data from surveys conducted in six distinct countries, namely Australia (HILDA), South Korea (KLIPS), Russia (RLMS), Switzerland (SHP), Germany (SOEP), and the United Kingdom (BHPS and UKHLS), our analysis discerns a consistent and statistically significant association between never-married status and lower levels of life satisfaction, a relationship that has exhibited no substantial alteration over time. Particularly noteworthy is the discernible reduction in life satisfaction among never-married individuals in South Korea in comparison to their married counterparts. The thesis concludes with a short summary in chapter five.
Essays on health and nutrition in China
(2015) Nie, Peng; Sousa-Poza, Alfonso
This dissertation aims to investigate several major socio-economic determinants of health and nutrition in China. By using data from the China Health and Nutrition Survey (CHNS) spanning from 1991 to 2009, this enhances the understanding of the transition of health and nutrition with such unprecedented economic and social changes in China. This dissertation contains six chapters: more specifically, Chapter 1 gives a brief description of general background, research aim and also the outline. Then Chapter 2 examines the association between maternal employment and childhood obesity. Chapter 3 takes a comprehensive look at how income changes are related to calorie intake. Chapter 4 investigates the impacts of peers (one of most important aspects of social networks) on childhood and adolescent adiposity. Chapter 5 assesses the nexus between long work hours and health. Finally, Chapter 6 ends with some main conclusions and discussions. Chapter 2 analyses the alarming increase of overweight and obese children and considers the higher female employment participation in China. We analyze how maternal employment is correlated with childhood obesity in China. Our work makes a non-Western comparison in this field, which is useful as it is rather difficult to generalize the results (mostly significant positive association between maternal employment and childhood obesity) from related studies in the Western world. More importantly, we further explore how maternal employment is related to two key transmitters of obesity: diet and physical activities. We find no association of maternal employment and childhood adiposity. Moreover, maternal employment is also not associated with either diet or physical activity of children. However, our results are well consistent with some recent evidence in Europe (Greve, 2011; Gwozdz et al., 2013), supporting the evidence that maternal employment might not necessarily be detrimental to child adiposity. One tentative explanation is that, the major source of informal childcare in China is grandparents, who are more likely to provide childcare with a high quality. In Chapter 3, we provide an empirical analysis that looks at the association between income and calorie intake via a variety of parametric, nonparametric and semiparametric approaches. By means of panel data settings, we are capable of capturing time-invariant individual heterogeneity. It is worth noting that taking a close look at calorie-income elasticities is crucial and implicative of the effectiveness of income-mediated policies for food security in China. Our findings provide strong evidence that calorie-income elasticities are small, irrespective of using parametric, nonparametric, or semiparametric techniques. Furthermore, these elasticities remain small when taking nonlinearities into consideration, and also for sub-analysis for gender, individuals with differences in calorie intake or even impoverished households. Although calorie-income are small, our results are well in line with some prior studies (Bishop et al., 2010; Lu and Luhrmann, 2012; Shankar, 2010; Zhong et al., 2012), suggesting that households might be quite successful in maintaining calorie intake stable as income changes. Also note, despite the marked increase in income, the Chinese demand for better food quality, food diversity and food safety have amplified (Gale and Huang, 2007; Liu et al., 2013b), instead of an increased demand for calorie intakes. Chapter 4 takes a detailed look at how peer effects are associated with childhood and adolescent obesity in China. It expands the empirical work beyond the Western domain in light of different cultural backgrounds between individualistic and collective societies. Furthermore, it broadens the dominant front of adolescents and adults by analyzing children as well. Note that, understanding peer effects on childhood adiposity is of great significance primarily because, as emphasized by Dishion and Tipsord (2011), children’s consumption behaviors are influenced by their peers. More importantly, childhood adiposity could result in persistent adulthood overweight or obesity (Loh and Li, 2013). In addition, the use of self-perceived perceptions of body weight allows for an exploration of the relation between peer effects and individual perceptions of weight status, thereby providing insights into understanding pathways by which peer effects operate within a relatively broader environment. We provide further evidence that peer effects exist not only among adolescents, but also children, suggesting that the formation of health lifestyles associated with peers is important for young children. In addition, we find that the magnitudes of peer effects change greatly over the distribution of individual BMI and stronger effects are observable at the upper end than at the bottom or median. This finding implies that obese individuals are more vulnerable to peers. Furthermore, females are more susceptible compared to males, which mirrors some U.S studies among adolescents (see, for instance, Trogdon et al., 2008). More importantly, we find that community-level average peer BMI is associated with self-perceived bodyweight in adolescents, providing evidence that a higher average peer BMI is related to the probability of a self-assessed perception of overweigh, in particular, for adolescent girls. All in all, our results support the existence of peer effects on childhood and adolescent obesity, but the magnitudes fall within the broader range for the U.S. adolescent studies using similar specification to ours. Therefore, it implies that peer effects do not necessarily strengthen within a collectivistic society, like China, as in comparison to the counterparts of an individualistic society, like the U.S. In Chapter 5, we provide a comprehensive picture of how long work hours are related to health, using not only subjective but also objective measures. Also, it provides a valuable comparison with existing studies predominantly in the Western world. More importantly, it explores several potential mechanisms through which long work hours could impact upon one’s health. In particular, it investigates the relation between long work hours and specific lifestyles, such as sleep, diet (calorie and fat intakes, time spent food preparation and cooking), physical activities (sports participation and time spent on sedentary activities). Apart from a cross-sectional settings, it also adopts a panel analysis, which allows for controlling for unobserved individual heterogeneity. Because, to the best of our knowledge, the only three studies in China (Fritjers et al., 2009; Verité, 2004; Zhao, 2008) all investigate subjective measures of health via cross-sectional data. We reveal that working above 50 hours per week (31-40 hours per week as the comparison), increases the probability of suffering from high blood pressure, though the effects are relatively small. Also, self-evaluated health is poorer for individuals working long hours compared with those weekly working 31-40 hours, however the effect is not so strong. Eventually, long work hours have various impacts of different aspects of individual lifestyles. Specifically, we cannot find a positive correlation between long work hours and obesity. Nevertheless, long work hours seem to be related to a decreased fat intake and less time spent on sedentary activity like watching TV. But, long work hours decrease the probability of sports participation. In summary, we provide limited evidence that long work hours in China have deleterious influences on health or lifestyles. Therefore, further research needs to explore the potential impacts of long work hours on other health or lifestyle measures. References Bishop, J.A. Liu, H.Y. & Zheng, B.H. 2010. Rising incomes and nutritional inequality in China. . In: BISHOP, J. A. (ed.) Studies in Applied Welfare Analysis: Papers from the Third ECINEQ Meeting. Bingley: Emerald Group Publishing. Dishion, T.J. & Tipsord, J.M. 2011. Peer contagion in child and adolescent social and emotional development. Annual Review of Psychology, 62, 189-214. Fritjers, P. Johnston, D.W. & Meng, X. 2009. The mental health cost of long working hours: the case of rural Chinese migrants. Mimeo. Greve, J. 2011. New results on the effect of maternal work hours on childrens overweight status: does the quality of child care matter? Labour Economics, 18(5), 579-590. Gwozdz, W. Sousa-Poza, A. Reisch, L.A. Ahrens, W. Henauw, S.D. Eiben, G. Fernandéz-Alvira, J.M. Hadjigeorgiou, C. De Henauw, S. Kovács, E. Lauria, F. Veidebaum, T. Williams, G. & Bammann, K. 2013. Maternal employment and childhood obesity - a European perspective. Journal of Health Economics, 32(4), 728-742. Gale, F. & Huang, K.S. 2007. Demand for food quantity and quality in China, Economic Research Report. No.32. Washington D.C. : US Department of Agriculture. Lu, L. & Luhrmann, M. 2012. The impact of Chinese income growth on nutritional outcomes. Available from Liu, R.D. Pieniak, Z. & Verbeke, W. 2013b. Consumers attitude and behaviour towards safe food in China: a review. Food Control, 33(1), 93-104. Loh, C.P. & Li, Q. 2013. Peer effects in adolescent bodyweight: evidence from rural China. Social Science & Medicine, 86, 35-44. Shankar, B. 2010. Socio-economic drivers of overnutrition in China. Journal of Human Nutrition and Dietetics, 23(5), 471-479. Trogdon, J.G. Nonnemaker, J. & Pais, J. 2008. Peer effects in adolescent overweight. Journal of Health Economics, 27(5), 1388-99. Verité 2004. Excessive overtime in Chinese supplier factories: causes, impacts and recommendations for action. Verité Research Paper, Amherst, Massachusetts. Zhong, F.N. Xiang, J. & Zhu, J. 2012. Impact of demographic dynamics on food consumption: a case study of energy intake in China. China Economic Review, 23(4), 1011-1019. Zhao, Z. 2008. Health demand and health determinants in China. Journal of Chinese Economic and Business Studies, 6(1), 77-98.
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 reallocating disaster relief payments towards subsidizing insurance markets
(2025) Philippi, Tim; Schiller, Jörg
This dissertation focuses on tax-financed disaster relief payments after natural catastrophes and examines whether reallocating some of these disaster relief payments towards subsidizing insurance markets can increase overall welfare. By lowering the price of insurance, more individuals are expected to buy insurance. Higher insurance demand should lower the size of future ex post disaster relief payments by the government. Individuals could benefit from higher levels of insurance coverage as it allows them to transfer a larger share of their risk to insurance companies. Paper 1 of the dissertation provides a theoretical framework to understanding how reallocating disaster relief payments towards subsidizing insurance markets affects expenditures of the government and welfare of the individuals. Paper 2 and Paper 3 study the German frost insurance market for winegrowers as different German state governments have recently implemented premium subsidies to increase frost insurance demand of winegrowers. In Paper 2, we study the first premium subsidy aimed at increasing frost insurance demand of German winegrowers. We find the premium subsidy in Baden-Württemberg to have strongly increased insurance demand. Winegrowers in Baden-Württemberg were very price responsive. In Paper 3, we broaden the analysis of Paper 2 by also studying premium subsidies in Rhineland- Palatinate, Bavaria and Saxony-Anhalt, whereby our main analysis compares Baden-Württemberg and Rhineland-Palatinate. We find both premium subsidies to have similar effects on frost insurance demand even though the subsidy in Rhineland-Palatiante seems to be more generous. We conclude that the flexible single-peril subsidy in Baden-Württemberg was more effective in the given context.
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).
Gambling advertising on social media
(2025) Singer, Johannes; Sousa-Poza, Alfonso
Digitalisation has made social media available worldwide and driven the global growth of the gambling industry. In response to these dynamic developments in a rapidly changing media landscape, the State Treaty on Gambling legalised online gambling in Germany in 2021. Providers are now also permitted to use advertising to direct interested parties to the legal gambling market. Since the legal gambling market, unless illegal gambling offers, is supervised by the German gambling authority, and providers must comply with applicable regulations, the aim is to protect the population, especially vulnerable groups, from gambling-related harm. However, advertising gambling can pose risks, especially for children and young people. A particularly high volume of gambling advertising appears on social media because these networks have established themselves as attractive advertising platforms. As children and young people are the most active social media users in Germany, they are likely to be exposed to a high level of gambling advertising on these platforms. Against this background, this dissertation analyses gambling advertising on social media in Germany for the first time. First, a systematic review provides an overview of the research literature on the advertising strategies of gambling providers and their effects on social media. To this end, three scientific databases were searched, and international journal articles in English published in or after 2021 were included. The review addresses the following four questions: (i) What are the characteristics of gambling advertising on social media? (ii) How do gambling advertisements and strategies affect users' attitudes and behaviour on social media? (iii) What safeguards are in place to protect individuals, particularly vulnerable groups, from gambling-related harm? (iv) What research gaps exist in the study of gambling advertising? Clearly, social media play a central role in gambling providers' advertising strategies. They can adapt their strategies flexibly to prevailing circumstances. However, the increasing intensity and complexity of gambling advertising, coupled with the blurring of boundaries between advertising and neutral content, appear problematic. Vulnerable groups, especially children and young people, are exposed to an increased risk as these forms of advertising are especially appealing to them. Furthermore, rapid developments make it difficult for regulatory authorities to keep up. The following chapter makes a first attempt to analyse the advertising strategies and content of German gambling providers on social media. For this purpose, various providers from different sectors are compared with each other. These include providers of sports betting, state lotteries, social lotteries, commercial lotteries, and casinos. The data analysis is based on tweets from selected accounts on the microblogging platform X (formerly Twitter) that were collected via the associated API. A mixed-methods approach is adopted, combining a qualitative summative content analysis with semi-supervised guided topic modelling to determine the frequency, number of followers, interactions, and content of the tweets. Overall, the accounts of German gambling providers demonstrate significantly lower activity levels than those of providers in other countries. Apart from the fact that all sports betting providers mainly used content from the 'News' category, no clear patterns emerged in the advertising strategies of the different providers or sectors. However, the ‘News’ content category was often used in combination with less neutral content categories. This is problematic given that most tweets had hardly any age restrictions or responsible gambling messages. Consequently, this leads to blurring of the distinction between neutral content and gambling advertisements, particularly when the latter is not explicitly identifiable as advertising. This advertising practice specifically endangers children and young people, despite the State Treaty on Gambling defining this target group as needing protection. Finally, a deep learning approach was employed to examine the stigmatisation of gambling disorder on the video platform YouTube in Germany and how it is expressed in the everyday language of users. As stigmatisation and self-stigmatisation are substantial barriers to therapy, and as young people are the age group most affected by gambling-related harm and the most active social media users, it is reasonable to assume that they encounter stigmatising statements on social media. This analysis combines guided topic modelling with qualitative summative content analysis to demonstrate the occurrence of statements associated with the stigmatisation of gambling disorder. Gambling disorder is associated with negative attributes and moral judgments. However, social media can also offer a suitable channel through which to protect young people from the negative consequences of stigmatisation and disseminate information to the general public, as well as targeted groups that are at risk. For example, attention could be drawn to treatment options or the fact that recovery is possible. It can also emphasise that seeking help is a sign of strength, not weakness. This highlights the potential of social media to help reduce the stigma surrounding gambling disorder. To summarise, the role of social media in the context of the State Treaty on Gambling can be described as ambivalent. On the one hand, they are suitable as an attractive advertising platform for gambling providers to address interested individuals and direct them to the state-monitored, legal gambling market. In this sense, they help to protect the population from gambling-related harm since legal gambling providers are subject to the control of the state gambling supervisory authority and must comply with applicable gambler protection regulations, such as advertising regulations. In addition, social media offers the opportunity to address a young age group and inform them about prevention options and offers of help. On the other hand, young people, as the most active user group on social media in Germany, are highly exposed to gambling advertising. Since young people in Germany are most frequently affected by a gambling-related disorder, this certainly seems problematic. High exposure to gambling advertisements harbours health risks, especially as such content is often not accompanied by age restrictions and responsible gambling messages. This blurs the lines between harmless content and gambling advertising. Furthermore, gambling providers can flexibly adapt their advertising strategies on social media to evolving conditions. The fast-moving changes in the media landscape and the advertising practices of gambling providers ultimately present the regulatory authorities with the challenge of keeping pace with these dynamic developments.
Gender, sentiment, and market power: Essays on market inefficiencies
(2024) Braegelmann, Kylie Ann; Schiller, Jörg
This dissertation contributes to the literature on financial market inefficiencies. In Chapter 2, my co-author and I investigate a two-pronged regulation in the German private health insurance market, revealing the mixed effectiveness of measures aimed at decreasing insurers’ acquisition costs and increasing value of insurance for consumers in a market where brokers have market power. While the introduction of a minimum cancellation liability period appears effective, a commission cap shows limited success and unintended consequences for new business. In Chapter 3, my co-author and I provide an empirical test of social role theory, analyzing the relationship between gender equality and perception of income fairness in European countries. The results imply that higher gender equality is associated with individuals of all genders perceiving their income as fair, suggesting societal returns to gender equality; moreoever, the results also provide weak evidence that perception of income fairness converges with higher gender equality, which is in line with social role theory. In Chapter 4, my co-author and I explore gender bias in market reaction to CEO announcements, finding a negative reaction to female CEOs, with the bias diminishing over time and varying by firm size. In Chapter 5, I conduct sentiment analysis on new CEO announcements, showing an overall tendency for firms to use positive sentiment in new CEO announcements, and demonstrating that investors react to narrative sentiment, even in a setting where it is unverifiable. Overall, these studies enhance our understanding of market inefficiencies and their regulatory challenges, providing valuable insights for both academic research and practical implications in financial markets.
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.
Incomes and asset poverty dynamics and child health among pastoralists in Northern Kenya
(2016) Mburu, Samuel; Sousa-Poza, Alfonso
In chapter one we identified the levels, sources, and trends of household incomes across the five survey waves. We also estimated and compared the income and asset poverty levels. Income poverty was estimated using imputed household income relative to the adjusted poverty line and asset poverty using a regression-based asset index and tropical livestock units (TLU) per capita. Our results indicate that keeping livestock is still the pastoralists’ main source of livelihood, although there is a notable trend of increasing livelihood diversification, especially among livestock-poor households. Majority of the households (over 70%) are both income and livestock poor with few having escaped poverty within the five-year study period. Disaggregating income and asset poverty also reveals an increasing trend of both structurally poor and stochastically non-poor households. The findings show that the TLU-based asset poverty is a more appropriate measure of asset poverty in a pastoral setting. In chapter two we explored the household welfare dynamics among pastoral households in the study area. First, we developed a microeconomic model to analyze the impact of a shock (e.g., a drought) on the behavioral decisions of pastoralists. Secondly, we estimated the existence of single or multiple dynamic equilibria that may constitute an asset poverty trap. We used the tropical livestock units (TLUs) to establish the shape of asset dynamics to locate the welfare equilibria for the sampled households. We also estimated the household characteristics and covariate environmental factors that influence livestock accumulation over time. We use both non-parametric and semi-parametric techniques to establish the shape of asset accumulation path and determine whether multiple equilibria exist. From the model, we found that a negative shock like a drought leads to an immediate decrease in livestock followed by a smooth reduction in consumption. Because the shock also affects the local economy, it prompts a wage decrease, which reinforces the pastoralist’s incentives to tend his own livestock and reduce time spent in the external labor market. Whereas the pastoralist’s labor time allocation shows a pattern of quick convergence, however, the adjustment of other variables such as consumption and capital takes much longer. Food aid helps in smoothening consumption especially among households with few livestock. We established that livestock assets converge to a single stable equilibrium implying that households remained livestock poor in the short term. Such convergence to a stable equilibrium could result from households with more livestock smoothening their consumption during times of food shortage by drawing on their herds for sale or consumption while livestock poor households smoothen their assets by using coping strategies that do not deplete their few livestock holdings. Poor households thus destabilized their consumption to buffer and protect their few assets for future income and survival. We also found that forage availability and herd diversity influenced livestock accumulation over time. In chapter three we established the extent of malnutrition among children by analyzing the levels of malnutrition among children aged five years and below. Additionally, we estimated the effects of drought, measured by the Normalized Difference Vegetation Index (NDVI), on child health outcomes. When the lack of sufficient rainfall reduces the levels of vegetative greenness, the corresponding lower NDVI values indicate forage scarcity. We followed the approach by Chantarat et al. (2012) and transformed the pure NDVI values to z-scores. We used the average NDVI Z-score values from long dry season (June, July, August, and September) for each survey year, extracted from four regions within Marsabit District. We then proxied the nutritional status of children using the mid-upper arm circumference (MUAC). We adjusted the MUAC for the age and sex of the child by converting the values to a MUAC Z-score based on WHO growth charts, as Z-scores are found to be better indicators of wasting than the fixed cut-off value (WHO 2009). The results show that malnutrition among children is prevalent in the study area, with approximately 20% of the children being malnourished and a one standard deviation increase in NDVI z-score decreases the probability of child malnourishment by 12–16 percent. The livestock insurance seems to be an effective risk management tool, as it slightly reduces the probability of malnutrition among children. Child health is also impacted by local conditions and family characteristics, which leave older children worse off than younger siblings who are still being breastfed or receive better care. In the most vulnerable households, boys are worse off than girls. At the same time, male-headed households tend to have healthier children, while family size is negatively associated with child MUAC. To reduce the effects of drought on child malnutrition, the targeting of food aid beneficiaries is crucial, and the use of remote sensing data could improve the effectiveness of these interventions. In chapter four we sought to understand the levels of school enrolment and gender differences in schooling given the challenges of accessibility to schools in the pastoral areas. First, we established levels of school enrolment by gender. Secondly, we estimated the effect of herd migration on school attendance and thirdly we gathered the community perceptions about challenges that school going children face and how they can be addressed. We used both household panel data for children aged between 6 and 15 years and community data obtained from some focus group discussions. Results showed that the effect of herd migration on school attendance is significant and negative: once other factors are controlled for, the predicted probability of child failure to attend school is 26% for households that migrate their livestock. On the other hand, attendance is positively impacted by the educational level of both the household head and his spouse. The analysis of survey data indicates that over the five years studied, school enrollment increased for both boys and girls, averaging 63.6% and 69.0%, respectively, in 2013. During the same period, the school dropout rate was quite low (less than 10%) although still higher among boys than among girls. The mean schooling efficiency (relative grade attained) was 0.67, which implies inefficiency in grade progression. Girls were better off than boys in terms of both grade attainment and staying in school, while children from more educated families showed a higher schooling efficiency than those from less educated families. At the same time, boys are less likely to attend school than girls, probably, the FGD participants confirmed, because boys engage in more economically valued activities like herding, which raises the opportunity costs of their absence for school. Girls, in contrast, engaged mostly in nonmonetizable household duties. Nevertheless, as key barriers to school attendance, the participants identified too few schools, nomadism and communal conflicts.
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.

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