Inefficiencies in a healthcare system with a regulatory split of power: a spatial panel data analysis of avoidable hospitalisations in Austria

Despite generous universal social health insurance with little formal restrictions of outpatient utilisation, Austria exhibits high rates of avoidable hospitalisations, which indicate the inefficient provision of primary healthcare and might be a consequence of the strict regulatory split between the Austrian inpatient and outpatient sector. This paper exploits the considerable regional variations in acute and chronic avoidable hospitalisations in Austria to investigate whether those inefficiencies in primary care are rather related to regional healthcare supply or to population characteristics. To explicitly account for inter-regional dependencies, spatial panel data methods are applied to a comprehensive administrative dataset of all hospitalisations from 2008 to 2013 in the 117 Austrian districts. The initial selection of relevant covariates is based on Bayesian model averaging. The results of the analysis show that supply-side variables, such as the number of general practitioners, are significantly associated with decreased chronic and acute avoidable hospitalisations, whereas characteristics of the regional population, such as the share of population with university education or long-term unemployed, are less relevant. Furthermore, the spatial error term indicates that there are significant spatial dependencies between unobserved characteristics, such as practice style or patients' utilization behaviour. Not accounting for those would result in omitted variable bias

Waiting time at health facilities and social class: Evidence from the Indian caste system.

Waiting time for non-emergency medical care in developing countries is rarely of immediate concern to policy makers that prioritize provision of basic health services. However, waiting time as a measure of health system responsiveness is important because longer waiting times worsen health outcomes and affect utilization of services. Studies that assess socio-economic inequalities in waiting time provide evidence from developed countries such as England and the United States; evidence from developing countries is lacking. In this paper, we assess the relationship between social class i.e. caste of an individual and waiting time at health facilities-a client orientation dimension of responsiveness. We use household level data from two rounds of the Indian Human Development Survey with a sample size of 27,251 households in each wave (2005 and 2012) and find that lower social class is associated with higher waiting time. This relationship is significant for individuals that visited a male provider but not so for those that visited a female provider. Further, caste is positively related to higher waiting time only if visiting a private facility; for individuals visiting a government facility the relationship between waiting time and caste is not significant. In general, caste related inequality in waiting time has worsened over time. The results are robust to different specifications and the inclusion of several confounders

Experimental approaches to studying cumulative cultural evolution

In humans, cultural traditions often change in ways which increase efficiency and functionality. This process, widely referred to as cumulative cultural evolution, sees beneficial traits preferentially retained, and it is so pervasive that we may be inclined to take it for granted. However, directional change of this kind appears to distinguish human cultural traditions from behavioural traditions that have been documented in other animals. Cumulative culture is therefore attracting an increasing amount of attention within psychology, and researchers have begun to develop methods of studying this phenomenon under controlled conditions. These studies have now addressed a number of different questions, including which learning mechanisms may be implicated, and how the resulting behaviours may be influenced by factors such as population structure. The current article provides a synopsis of some of these studies, and highlights some of the unresolved issues in this field

Human teaching and cumulative cultural evolution

Although evidence of teaching behaviour has been identified in some nonhuman species, human teaching appears to be unique in terms of both the breadth of contexts within which it is observed, and in its responsiveness to needs of the learner. Similarly, cultural evolution is observable in other species, but human cultural evolution appears strikingly distinct. This has led to speculation that the evolutionary origins of these capacities may be causally linked. Here we provide an overview of contrasting perspectives on the relationship between teaching and cultural evolution in humans, and briefly review previous research which suggests that cumulative culture (here meaning cultural evolution featuring a trend towards improving functionality) can occur without teaching. We then report the results of a novel experimental study in which we investigated how the benefits of teaching may depend on the complexity of the skill to be acquired. Participants were asked to tie knots of varying complexity. In our Teaching condition, opportunities to interact with an experienced partner aided transmission of the most complex knots, but not simpler equivalents, relative to exposure to completed products alone (End State Only condition), and also relative to information about the process of completion (Intermediate States condition). We conclude by considering the plausibility of various accounts of the evolutionary relationship between teaching and cultural evolution in humans

An economic analysis of public cultural subsidies

Diese Diplomarbeit beschäftigt sich mit der finanziellen Unterstützung von kulturellen Einrichtungen und künstlerischen Tätigkeitsfeldern, wobei ein Schwerpunkt auf die öffentliche Subventionierung von kulturellen Institutionen gelegt wird. Die Arbeit diskutiert die verschiedenen Möglichkeiten öffentlicher und privater Unterstützung und die Gründe derselben.Die messbaren ökonomischen Effekte des Kultursektors im Allgemeinen und von bestimmten Institutionen im Besonderen können durch eine Input-Output Analyse erfasst werden. Diese wird in einem Abschnitt der Arbeit vorgestellt und in einem anderen auf die Wiener Staatsoper angewandt. So soll die wirtschaftliche Bedeutung des Opernhauses für die österreichische Volkswirtschaft sichtbar gemacht werden.This thesis examines the financial support for cultural institutions and artistic activities in general and concentrates in particular on public subsidies for arts institutions. The work discusses the various methods of and the reasons for governmental and private support to the arts.To estimate the measurable economic effects of the cultural sector and of specific cultural institutions the Input-Output system is introduced as methodological background. In the last part of this work the economic effects of the Wiener Staatsoper are calculated and analyzed to underline the significance of cultural institutions for the national economy

Editorial for the Special Issue “Spatial and regional aspects of health”

The health crisis caused by the COVID-19 pandemic highlights, more than ever, the necessity of scientific research to inform policy action. During such a crisis it is vital that any measure taken by policy makers mitigates the consequences on health without causing long-lasting social and economic harm. Spatial aspects play an important role here: knowledge about the spread of a disease through space and social networks, the effectiveness of different policy responses, and the economic and social implications for the population are of particular relevance. As any policy action is embedded in its institutional and social environment, not every measure is effective in all contexts. Moreover, infectious diseases can spread at different speed in different places, requiring tailored interventions. Careful evaluation and comparison of different settings, including the organization of the healthcare systems and the geographic and demographic characteristics of a region or country, are therefore essential. The COVID-19 pandemic has made manifest the importance of the spatial and geographical dimension of health, however, the relevance of this interlinkage is not limited to the spread of contagious diseases. Differences in accessibility of services between urban and rural regions, the varying costs of access to healthcare for different (socioeconomic) groups of the population, the impact of these on healthcare utilization, and environmental shocks on population health are just a few examples illustrating the close link between space, socioeconomic factors and health. This special issue of REGION is presented in two parts. In the first part, papers explore the spread and impact of the COVID-19 pandemic on the health and economy. In the second part, papers investigate regional and spatial aspects of the healthcare sector with a focus on health disparities

Editorial for the Special Issue "Spatial and regional aspects of health"

The health crisis caused by the COVID-19 pandemic highlights, more than ever, the necessity of scientific research to inform policy action. During such a crisis it is vital that any measures taken by policy makers mitigate the consequences of risks without causing long-lasting social and economic harm. Spatial aspects play an important role here: knowledge about the spread of a disease through space and social networks, the effectiveness of different policy responses, and the economic and social implications for the population are of particular relevance. As any policy action is embedded in its institutional and social environment, not every measure is effective in all contexts. Moreover, infectious diseases can spread at different speed in different places, requiring tailored interventions. Careful evaluation and comparison of different settings, including the organization of the healthcare systems and the geographic and demographic characteristics of a region or country, is therefore essential. The COVID-19 pandemic has made manifest the importance of the spatial and geographical dimension of health, however, the relevance of this interlinkage is not limited to the spread of contagious diseases. Differences in accessibility of services between urban and rural regions, the varying costs of access to healthcare for different (socioeconomic) groups of the population, the impact of these on healthcare utilization, and environmental shocks on population health are just a few examples illustrating the close link between space, socioeconomic factors and health. This special issue of REGION is presented in two parts. In the first part, papers explore the spread and impact of the COVID-19 pandemic on the health and economy. In the second part, papers investigate regional and spatial aspects of the healthcare sector with a focus on health disparities

Barrieren für die Inanspruchnahme Früher Hilfen: die Rolle der elterlichen Steuerungskompetenz

Hintergrund: Es ist bekannt, dass Angebote für Familien mit kleinen Kindern nicht alle Eltern gleichermaßen erreichen. Oft sind es gerade diejenigen Familien, die aufgrund erhöhter Belastungen am meisten von den Angeboten profitieren könnten, die nicht erreicht werden (Präventionsdilemma). Ziel: Es wird der Frage nachgegangen, ob Eltern sich anhand ihrer Einstellung zu Gesundheit, Prävention und Angeboten für Familien unterscheiden lassen und inwiefern die Zugehörigkeit zu einer anhand der Einstellung identifizierten Gruppe Einfluss auf die Nutzung von Angeboten (der primären und sekundären Prävention) rund um Schwangerschaft und Geburt hat. Methoden: Eltern von Kindern im Alter von zwei bis vier Jahren (N=273) füllten im Rahmen von Hausbesuchen einen standardisierten Fragebogen aus; 203 Eltern nahmen zusätzlich an qualitativen Interviews teil. Ergebnisse: Eltern unterschiedlicher sozialer Milieus konnten anhand der Interviews in Gruppen mit niedriger und hoher "Steuerungskompetenz" eingeteilt werden. Eltern mit hoher und niedriger Steuerungskompetenz unterscheiden sich bei der Kenntnis und Inanspruchnahme von und Zufriedenheit mit Angeboten für Familien; insbesondere Angeboten der primären Prävention. Steuerungskompetenz leistet - über soziodemografische Kontrollvariablen und Belastungsfaktoren hinaus - einen erklärenden Beitrag zur Inanspruchnahme von Angeboten der primären Prävention. Die Inanspruchnahme von Angeboten der sekundären Prävention wird eher von verschiedenen Belastungsfaktoren vorhergesagt. Diskussion: Ergebnisse werden im Hinblick auf ungenutzte Angebote und Möglichkeiten einer zielgruppenorientierten Ansprache diskutiert.Background: It is well established that preventive measures for pregnant women and families with small children do not reach all families alike. Often enough, it is those families, who due to heightened stresses and strains might gain the most from these measures, who cannot be reached (dilemma of prevention). Goal: This investigation explores whether parents can be grouped according to their views on health, prevention and measures available to young families, and whether belonging to one of the identified groups explains differences in the use of (primary and secondary) preventive measures for pregnant women and young families. Method: In the context of home visits, parents of children aged two to four years (N=273) completed questionnaires. Additionally, 203 parents took part in qualitative interviews. Results and discussion: Based on interview data, parents from different sociocultural backgrounds could be grouped along their expected ability to control sources for parental support (Steuerungskompetenz). Parents high and low in Steuerungskompetenz differ regarding their knowledge of, use of, and satisfaction with (primary) preventive measures. Steuerungskompetenz explains the use of primary preventive measures above and beyond socioeconomic control variables as well as family stresses and strains. The use of secondary preventive measures is better explained by family stresses and strains. Results are discussed in terms of untapped services, needs and possibilities of target group-oriented approach

Migratory grief: a systematic review

IntroductionMigration is often accompanied by interpersonal, material and abstract losses and can be associated with migratory grief. The correlates of migratory grief have not yet been sufficiently addressed in research. This review aims to systematically investigate the relationship between migratory grief and psychopathology, to map the current state of research on this highly relevant topic and to derive relevant implications for the target group.MethodA systematic literature search of electronic databases (PubMed/Medline, PsycINFO, Web of Science) was conducted up until January 2023. Primary empirical quantitative and qualitative studies with migrants were included that assessed the association between migratory grief and psychopathology, using a specific instrument for migratory grief (quantitative) or named migratory grief as relevant topic (qualitative). Studies that only captured aspects of migratory grief, were not written in English, or were descriptive/non-peer-reviewed publications, were excluded. A quality assessment of all studies included was performed using the Mixed Methods Appraisal Tool. The results were synthesized using a narrative synthesis approach.ResultsAll studies (quan. = 4; qual. = 1) were cross-sectional and used convenience samples. The studies had a mean number of 83 participants with a total of N = 487 participants included in the current review. All included studies reported a significant relationship between migratory grief and psychological distress.DiscussionDespite the quality of the included studies being limited, our results show that there is a link between migratory grief and depression among refugees and migrants. However, there are only few studies in this currently and certainly also in the future relevant field of research, which is why further studies on factors influencing migratory grief as well as associations with other disorders would be desirable.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023403448