The self-regulatory German health care system between growing competition and state hierarchy

This article focuses on the changing role of the state in financing, providing and regulating health care services under the German health care system from 1970-2000. While a reduced role of the state can be observed in terms of financing, our analysis of service provision indicates inconsistent developments. Monetary resource flow analyses indicate a decrease in private service provision as a percentage of total health expenditure, but when analysing the development of health employment we see a growth in "private" health care personnel. The most important changes, however, have taken place in terms of regulation. Since the early 1990s, the traditionally self-regulatory German health care system has simultaneously faced growing competition and state hierarchy. -- Thema des Beitrags ist die sich ändernde Rolle des Staates in der Finanzierung, Leistungserbringung und Regulierung im deutschen Gesundheitssystem zwischen 1970 und 2000. Während sich bei der Finanzierung von Gesundheitsleistungen ein Rückzug des Staates abzeichnet, ergibt die Analyse der Leistungserbringung keinen einheitlichen Trend. Gemessen in Prozent der Gesamtausgaben für Gesundheit zeigt die Untersuchung der monetären Ressourcen eine Reduzierung der privaten Leistungserbringung, wohingegen bei der Analyse des Gesundheitspersonals ein Anstieg der privaten Leistungserbringung zu erkennen ist. Die wichtigsten Änderungen erfolgten allerdings im Bereich der Regulierung. Seit den frühen 1990er Jahren befindet sich das traditionell selbstverwaltete deutsche Gesundheitssystem zunehmend in einer Umklammerung aus staatlicher Regulierung einerseits und Wettbewerb andererseits.

Zehn Jahre ökonomische Forschung zum ökologischen Landbau in der FAL

Der ökologische Landbau ist schon seit Mitte der 80er Jahre Forschungsgegenstand in den agrar-ökonomischen Instituten der FAL. Schwerpunktmäßig wurden folgende Themenkomplexe zum ökologischen Landbau bearbeitet: Wirtschaftlichkeit; Analyse der Förderung in Deutschland; Auswirkungen der EU-Agrarpolitik; internationale Wettbewerbsfähigkeit; Markstruktur; Verbraucherverhalten; Marktinformationssystem. In diesem Beitrag werden die bearbeiteten Themenkomplexe kurz skizziert und wichtige Ergebnisse vorgestellt. Ausblickend wird festgehalten, dass in Zukunft im Rahmen der Forschung vor allem internationale Analysen bezogen auf Wettbewerbsfähigkeit und Marktentwicklung, Fragen zum optimalen Politikdesign sowie sozio-ökonomische Fragestellungen an Bedeutung gewinnen werden

Public Support of the Processing and Marketing of Agricultural Products: A Driver of Innovation in the Food Industry?

At issue in this paper is the role of innovation within the public support of food-industries under EU rural development policy. It is focused on the questions: Are there fundamental economic characteristics of highly innovative in comparison to less innovative enterprises? And, what are successful strategies to promote innovations by intervention of the state. Baseline information is given through the data ascertainment of investment grant applications and collaboration with local state departments.Innovation, industrial policy, investment assistance, food-industry, state-intervention, Agribusiness, Agricultural and Food Policy, Marketing,

Convergence of divergence of OECD health care systems

This article focuses on two major questions concerning the changing role of the state in the health care systems of OECD countries. Firstly, we ask whether major changes in the level of state involvement (in health care systems) have occurred in the past thirty years. Given the fact that three types of health care systems - which are characterized by a distinct role of the state - evolved during the golden age, we secondly discuss how this distinctiveness - or more technically: variance - has changed in the period under scrutiny. While many authors analysing health policy changes exclusively concentrate on finance and expenditure data, we simultaneously consider financing, service provi-sion, and regulation. As far as financing is concerned, we observe a small shift from the public to the pri-vate sphere with a tendency towards convergence in this dimension. Expanding Peter Flora´s `growth to limits´ theses, due to the ongoing increase of total financing and the melting off of the public share `private growth and public limits´ might be a future trend in the financing dimension of health care systems. The few data available on ser-vice provision, in contrast, show neither signs of retreat of the state nor of convergence. In the regulation dimension - which we analyse by picking major health system reforms in Germany, the United Kingdom and the United States - we see the introduction or strengthening of those coordination mechanisms (hierarchy, markets and self-regulation) which were traditionally weak in the respective type of health care system. `Gate-keeping´ and DRG models are remarkable examples to show that health policy might increasingly be oriented at `best practices´ even when the respective solutions are beyond the traditional path of reforms. Putting these findings together we find a ten-dency of convergence from distinct types towards mixed types of health care systems. - --

linking goal-directed and model-based behavior

In experimental psychology different experiments have been developed to assess goal–directed as compared to habitual control over instrumental decisions. Similar to animal studies selective devaluation procedures have been used. More recently sequential decision-making tasks have been designed to assess the degree of goal-directed vs. habitual choice behavior in terms of an influential computational theory of model-based compared to model-free behavioral control. As recently suggested, different measurements are thought to reflect the same construct. Yet, there has been no attempt to directly assess the construct validity of these different measurements. In the present study, we used a devaluation paradigm and a sequential decision-making task to address this question of construct validity in a sample of 18 healthy male human participants. Correlational analysis revealed a positive association between model-based choices during sequential decisions and goal-directed behavior after devaluation suggesting a single framework underlying both operationalizations and speaking in favor of construct validity of both measurement approaches. Up to now, this has been merely assumed but never been directly tested in humans

Maßnahmen und Ansatzpunkte zur Verbesserung der quantitativen Marktinformationen bei Öko-Produkten und Möglichkeiten ihrer Konkretisierung

Eine Verbesserung der unzureichenden Datenbasis über den Öko-Markt in Deutschland stand im Mittelpunkt des Projektes. Dazu wurden bestehende Datenquellen daraufhin geprüft, ob sie die gewünschten Daten liefern und für welche Vermarktungsebenen bereit stellen können. Die ursprünglich angedachte Totalerfassung über die Kontrollstellen erwies sich als nicht umsetzbar. Zweckmäßige Erweiterungen vorhandener Statistiken und Erhebungen zur Informationsbeschaffung für den Öko-Bereich wurden am Beispiel Öko-Mühlen getestet. Trotz deren grundsätzlicher Zustimmung zum Vorhaben waren ihre Mitwirkung und das Ergebnis enttäuschend. Der Aufwand, der nötig wäre, um eine solche freiwillige Form der Datengewinnung breit und dauerhaft in der Praxis zu implementieren, ist sehr hoch. Alternativ wurde die Ausweitung der Meldepflichten im Rahmen bestehender Erhebungen untersucht. Auch dieser Ansatz erwies sich als sehr aufwändig und in der Praxis aufgrund nicht ausreichend vorhandener Bereitschaft zur Unterstützung als nicht realisierbar. In einer Primärerhebung wurden 71 Erzeugergemeinschaften/Erzeugerzusammenschlüsse ermittelt. 69 von ihnen machten Angaben über die von ihnen erfassten und vermarkteten Öko-Produkte. Sie flossen in aktuelle Übersichten über Marktstruktur und Absatzwege, Nachfrage, Angebot sowie Preise auf wichtigen Öko-Märkten und ihrer Entwicklungstendenzen ein. Diese Marktübersichten wurden für die Produktbereiche Getreide, Obst, Gemüse, Kartoffeln, Milch, Fleisch und Eier erstellt, wobei im Fleischbereich noch nach Rindfleisch, Schweinefleisch und Geflügelfleisch differenziert wurde. Damit konnte die Informationsbasis über die genannten Öko-Märkte aktualisiert und deutlich verbreitert werden. Neben der Ermittlung verlässlicher und belastbarer Ausgangsdaten ist auch die Bereitstellung der Daten in geeigneter und ansprechender Form als ein wesentlicher Schritt zur Erhöhung der Markttransparenz anzusehen. Dazu wurde im Rahmen des Projektes eine Datenbank erstellt. Sie enthält zahlreiche Informationen zur Produktion, zum Handel, zu einzelnen Unternehmen, zur Verbraucherebene und zu Fördermaßnahmen. Im Nachgang zu diesem Projekt soll sie internetfähig gemacht werden

Erratum to: ‘Early prediction of acute kidney injury after transapical and transaortic aortic valve implantation with urinary G1 cell cycle arrest biomarkers’

Background: Acute kidney injury (AKI) is a common complication following transcatheter aortic valve implantation (TAVI) leading to increased mortality and morbidity. Urinary G1 cell cycle arrest proteins TIMP-2 and IGFBP7 have recently been suggested as sensitive biomarkers for early detection of AKI in critically ill patients. However, the precise role of urinary TIMP-2 and IGFBP7 in patients undergoing TAVI is unknown. Methods: In a prospective observational trial, 40 patients undergoing TAVI (either transaortic or transapical) were enrolled. Serial measurements of TIMP-2 and IGFBP7 were performed in the early post interventional course. The primary clinical endpoint was the occurrence of AKI stage 2/3 according to the KDIGO classification. Results: Now we show, that ROC analyses of [TIMP-2]*[IGFBP7] on day one after TAVI reveals a sensitivity of 100 % and a specificity of 90 % for predicting AKI 2/3 (AUC 0.971, 95 % CI 0.914-1.0, SE 0.0299, p = 0.001, cut-off 1.03). In contrast, preoperative and postoperative serum creatinine levels as well as glomerular filtration rate (GFR) and perioperative change in GFR did not show any association with the development of AKI. Furthermore, [TIMP2]*[IGFBP7] remained stable in patients with AKI = 1, but its levels increased significantly as early as 24 h after TAVI in patients who developed AKI 2/3 in the further course (4.77 +/- 3.21 vs. 0.48 +/- 0.68, p = 0.022). Mean patients age was 81.2 +/- 5.6 years, 16 patients were male (40.0 %). 35 patients underwent transapical and five patients transaortic TAVI. 15 patients (37.5 %) developed any kind of AKI;eight patients (20 %) met the primary endpoint and seven patients required renal replacement therapy (RRT) within 72 h after surgery. Conclusion: Early elevation of urinary cell cycle arrest biomarkers after TAVI is associated with the development of postoperative AKI. [TIMP-2]*[ IGFBP7] provides an excellent diagnostic accuracy in the prediction of AKI that is superior to that of serum creatinine

Pavlovian-to-Instrumental Transfer in Alcohol Dependence: A Pilot Study

This publication is with permission of the rights owner freely accessible due to an alliance licence and a national licence (funded by the DFG, German Research Foundation) respectively.Background: Pavlovian processes are thought to play an important role in the development, maintenance and relapse of alcohol dependence, possibly by influencing and usurping ongoing thought and behavior. The influence of pavlovian stimuli on ongoing behavior is paradigmatically measured by pavlovian-to-instrumental transfer (PIT) tasks. These involve multiple stages and are complex. Whether increased PIT is involved in human alcohol dependence is uncertain. We therefore aimed to establish and validate a modified PIT paradigm that would be robust, consistent and tolerated by healthy controls as well as by patients suffering from alcohol dependence, and to explore whether alcohol dependence is associated with enhanced PIT. Methods: Thirty-two recently detoxified alcohol-dependent patients and 32 age- and gender-matched healthy controls performed a PIT task with instrumental go/no-go approach behaviors. The task involved both pavlovian stimuli associated with monetary rewards and losses, and images of drinks. Results: Both patients and healthy controls showed a robust and temporally stable PIT effect. Strengths of PIT effects to drug-related and monetary conditioned stimuli were highly correlated. Patients more frequently showed a PIT effect, and the effect was stronger in response to aversively conditioned CSs (conditioned suppression), but there was no group difference in response to appetitive CSs. Conclusion: The implementation of PIT has favorably robust properties in chronic alcohol-dependent patients and in healthy controls. It shows internal consistency between monetary and drug-related cues. The findings support an association of alcohol dependence with an increased propensity towards PIT.Peer Reviewe