Federal States Of Germany Research Articles

Überführung des AGnES-Konzeptes in die Regelversorgung: Juristische Bewertung, Vergütung, Qualifizierung

According to an amendment of German social security legislation, the AGnES concept of delegation of certain tasks of medical care, especially house calls, by general practitioners (GPs) to qualified practice employees (AGnES employees), will be transferred into the regular German health care system from January 2009 onward. The concept was developed to support GPs in regions with imminent gaps in primary care. Patient data, the specifically delegated and all other activities carried out by the AGnES employees in the AGnES projects were digitally documented. Additionally, the participating GPs, AGnES employees and patients underwent a set of standardised interviews. A curriculum to qualify the AGnES employees and to define the requirements needed was developed. A legal assessment of all delegated activities was carried out, and an economical model to calculate the necessary allowance was calculated. In seven model projects in four federal states in Germany, 11,228 house calls were carried out involving 1,424, mostly multimorbid, patients (mean age: 78.6 years). A modular structured curriculum, considering the basic education and acquired competences, was developed. It allows for an individual qualification of the AGnES employees. The result of the legal assessment was the central relevance of the qualification of the practice employees according to the AGnES curriculum as the essential condition for carrying out the entire range of activities of the AGnES concept. The economic model revealed euro 21.58 for a house call by an AGnES employee. The underlying model referred to underserved regions. A successful transfer of the AGnES concept with a high standard of quality into regular health-care depends on several factors. Of particular importance is the specific qualification of the practice employees, which is a central legal condition for the delegation of medical tasks from GPs to AGnEs employees. A second determining factor is also an adequate reimbursement within the catalogus of the statutory health insurances.

Inwieweit bilden definierte Tagesdosen (DDD) die tatsächlich verordneten Tagesdosen ab? Eine Analyse ambulanter Verordnungsdaten

Defined daily doses (DDD) are used to analyse drug utilisation. For frequently prescribed drug groups, we studied to what extent the DDD correspond to the average prescribed daily doses (PDD). We analysed all drugs prescribed for more than three months to insured of a large health insurance fund in Mecklenburg-Vorpommern, one federal state in Germany. PDD for plain ACE inhibitors, selective beta-antagonists and some antidiabetics (sulfonylurea compounds) were calculated and compared with their DDD. During the study period, about 38 500 patients received continuous prescriptions of each ACE inhibitors or selective beta-antagonists, and about 9 000 of sulfonylurea compounds. PDD differed from DDD in varying degrees. For ACE inhibitors, PDD ranged between 1.5 DDD (for captopril) and 3.5 (for ramipril). The PDD for beta antagonists were on average 0.9 DDD, similar for bisoprolol (0.8 DDD) and metoprolol (0.9 DDD). As for oral antidiabetics, doctors prescribed 1.0 DDD glibenclamid per day and patient and 2.0 DDD glimepirid. Depending on differences between DDD and PDD, real daily costs for drug therapy differed from the theoretical costs per DDD, for example in the case of ramipril they were 0.24 euros compared to 0.07 euros. The PDD were much higher than the DDD for several frequently prescribed drugs. Consequently, the daily drug costs exceeded the drug costs based on DDD. Evaluations of drug costs on the basis for DDD require careful interpretation. Moreover, the number of DDD alone is not a valid measurement for the appropriateness of drug therapy and can only give a rough estimate of the number of patients treated, at least for the drug groups in this study.

Prüfanleitung für die Durchführung der ergänzenden Prüfpositionen nach EPQC 4thEdition für digitale Mammografie-Systeme

Within the physical-technical quality assurance of the German breast cancer screening program all digital mammography systems have to perform the contrast resolution test and the determination of the average glandular dose based on the European guidelines for quality assurance in breast cancer screening and diagnosis (4th Edition). Since 1.1.2009 this applies to digital systems outside the screening program too. To accomplish uniform measurements in all federal states of Germany, the physical board of the reference centers developed together a special guideline for these test position. This Guideline describes the determination of the average glandular dose for different types of mammography systems, the CDMAM image acquisition and the CDMAM image evaluation as well. This guideline was verified by the German task group "Röntgenverordnung".

Physical and Personnel Infrastructures and Their Impact on Economic Growth of German Federal States (Outputeffekte von Infrastrukturen in Ost- und Westdeutschland)

This paper addresses the question if physical infrastructure and personnel infrastructure (i.e. human capital) are positively related to economic output. Relevant theoretical literature provides a variety of arguments concerning a positive impact of infrastructure endowment on economic out-put. First, infrastructure is a production input and raises productivity of firms or reduces their marginal costs. Second, an advanced and efficient infrastructure endowment is a competitive asset and helps to improve factor allocation. Third, the New Economic Geography points out that infrastructure has the potential to reduce disparities among regions by the diffusion of knowledge spillovers. Marginal output effects are likely to decrease, regarding an increasing infrastructure endowment. The effect will be negative if there is an overinvestment in physical infrastructure, as is the case for transport infrastructures in Germany. Empirical results concerning the relationship between physical infrastructure endowment and economic output are ambiguous. A shortfall of most infrastructure studies is their missing solution to the problem of endogeneity. This paper presents a way to address the problem of endogeneity more properly. Using data on 16 federal states in Germany an empirical analysis of infrastructural output effects based on a Panel Vector Autocorrelation Model (PVAR) is conducted for the period from 1993 to 2005. This analysis offers practical benefits for economic policy. With respect to the recently ratified economic stimulus package and the vast infrastructure investments of the last 20 years in East Germany it is fundamentally important to observe if the expansion of physical infrastructure will further contribute to economic growth and if the infrastructure endowment of East Germany causes larger output effects than they would in West Germany. As a result of this analysis the last question can be answered with yes. While total transport infra-structure (throughout all states) causes negative output effects and implies an overinvestment, transport infrastructures in East Germany have a positive impact. Contrarily, human capital causes larger output effects in West German than in East German States.

Calculation of health expectancies with administrative data for North Rhine-Westphalia, a Federal State of Germany, 1999–2005

ObjectivesThe main objectives of this study were to prove the feasibility of health expectancy analyses with regional administrative health statistics and to explore the utility of the calculated health expectancies in describing the health state of the population living in North Rhine-Westphalia, a Federal State of Germany.Materials and methodsAdministrative population and mortality data as well as health data on disability and long-term care provided by public services were used to calculate: a) the life expectancy and b) the health expectancies Severe-Disability-Free Life Expectancy (SDFLE) and Long-Term-Care-Free Life Expectancy (LTCFLE) from 1999 to 2005. Calculations were done using the Sullivan method.ResultsSDFLE at birth was 69.9 years (males 66.2 and females 73.2 years) in 1999 and it increased to 71.7 years (males 68.6 and females 74.7 years) in 2005. The proportion of the SDFLE on the total life expectancy at birth was 89.8% (males 88.6 and females 90.8%) in 1999 and 90.7% (males 89.8 and females 91.4%) in 2005.LTCFLE at birth was 75.3 years (males 73.1 and females 77.5 years) in 1999 and it increased to 76.6 years (males 74.7 and females 78.6 years) in 2005. The proportion of the LTCFLE on the total life expectancy at birth was 96.8% (males 97.8 and females 96.1%) in 1999 and 96.8% (males 97.8 and females 96.2%) in 2005.Discussion and conclusionBoth health expectancies indicate an improvement in the quantity as well as in the quality of healthy life for the population living in North Rhine Westphalia and therefore suggest a compression of morbidity from 1999 to 2005. The findings however have several limitations in their sensitivity, since we applied dichotomous valuations to the health states. In addition, the results are restricted to comparisons over time because the morbidity concepts do not allow for comparisons with populations other than the German one. Refined calculations with other summary measures of population health and with health data on other morbidity concepts are therefore reasonable.

Output Effects of Infrastructures in East and West German States

This paper addresses the question if physical infrastructure and personnel infrastructure (i.e. human capital) are positively related to economic output. Relevant theoretical literature provides a variety of arguments concerning a positive impact of infrastructure endowment on economic out-put. First, infrastructure is a production input and raises productivity of firms or reduces their marginal costs. Second, an advanced and efficient infrastructure endowment is a competitive asset and helps to improve factor allocation. Third, the New Economic Geography points out that infrastructure has the potential to reduce disparities among regions by the diffusion of knowledge spillovers. Marginal output effects are likely to decrease, regarding an increasing infrastructure endowment. The effect will be negative if there is an overinvestment in physical infrastructure, as is the case for transport infrastructures in Germany. Empirical results concerning the relationship between physical infrastructure endowment and economic output are ambiguous. A shortfall of most infrastructure studies is their missing solution to the problem of endogeneity. This paper presents a way to address the problem of endogeneity more properly. Using data on 16 federal states in Germany an empirical analysis of infrastructural output effects based on a Panel Vector Autoregression Model (PVAR) is conducted for the period from 1993 to 2005. This analysis offers practical benefits for economic policy. With respect to the recently ratified economic stimulus package and the vast infrastructure investments of the last 20 years in East Germany it is fundamentally important to observe if the expansion of physical infrastructure will further contribute to economic growth and if the infrastructure endowment of East Germany causes larger output effects than they would in West Germany. As a result of this analysis the last question can be answered with yes. While total transport infra-structure (throughout all states) causes negative output effects and implies an overinvestment, transport infrastructures in East Germany have a positive impact. Contrarily, human capital causes larger output effects in West German than in East German States.

Construction of Regional Input-Output Tables Using Nonsurvey Methods

Regional input-output tables are usually not constructed from survey data but are estimated using nonsurvey regionalization methods, which saves time and money. However, traditional regionalization methods ignore cross-hauling (the simultaneous exporting and importing of one and the same type of product). This flaw results in an underestimation of trade and an overestimation of regional output multipliers. This article presents a new approach based on an estimate of product heterogeneity, which addresses the problem of cross-hauling and is applicable to European System of Accounts tables with indirectly allocated imports. Its application is illustrated by the estimation of a regional input-output table for North Rhine—Westphalia, one of Germany's federal states. The results are compared to the traditional commodity balance approach, indicating that the new method suffers far less from the underestimation of trade and the overestimation of multipliers.

Pending property issues in the new federal states of Germany—cause of the phenomenon of “sleeping owners”

Pending property issues in the new federal states of Germany—cause of the phenomenon of “sleeping owners”

A statistics-based method for cluster analysis of the forest sector at the national and subnational level in Germany

The cluster concept in economics contributes to new research on the forest sector's role in national and regional economies, yet incompatible cluster definitions and a variety of methodologies impede an objective comparison of findings. However, governmental statistical reporting systems are not well suited for a direct assessment of the forest sector due to classificatory and methodological shortcomings. This research presents a more standardized approach in the form of a statistics-based method for forest sector benchmarking and monitoring. The specification of the method included an extended cluster definition based on the Classification of Economic Activities in the European Union (NACE) and the validation of two suitable national statistical reporting systems. Testing the method in a case study for Germany demonstrates its capacity to provide consistent socioeconomic information on forest and wood-based industries in a sectoral, spatial and temporal dimension. In 2004, the German forest cluster accounted for 100,000 companies, 150 billion Euro gross turnover and over 900,000 employees (approximately 3.5% of the national economy) and ranked among the strongest manufacturing sectors. Individual wood-based industries indicated regional concentrations in federal states of Germany. Over the past decade, the forest sector was marked by considerable losses in turnover and employment, which increasingly deviated from the overall economic development of Germany. The research contributes to a more standardized, empirical understanding of the forest sector's role in national and regional economies, supporting rational decision making in cluster policy and management.

Patentanmeldungen im Ruhrgebiet — Stärken und Schwächen im Vergleich von Agglomerationen

Patent applications — a result of innovation activities and a leading indicator for technical developments — are concentrated in agglomerations. Therefore, patent applications from the Ruhr Area are compared with those in other urban centres. Their level and development within the Ruhr area are below average. Nevertheless, they possess certain strengths: in some technical fields such as chemistry an above-average proportion and development can be observed. In addition, there is a bigger variability of patent applications within the Ruhr area than in other regions. Additionally, there are other nearby areas with a high level of researching activities in NRW. Consequently, networking seems to be more promising than in other federal states in Germany.

Comparison of agricultural income in Hungary and the New Federal States of Germany

There are a lot of literatures that investigate the agricultural transition both in Hungary and former GDR. However there is no one, which examines and compares the income situation in the above mentioned countries. The aim of this article is to analyse that. The investigation is based on the data of Economic Accounts for Agriculture (EAA). The result shows that the agricultural income is much higher in the New Federal States of Germany if we take into account the subsidies, however without subsidies it would be higher in Hungary.

Why are Working-class Children Diverted from Universities?--An Empirical Assessment of the Diversion Thesis

In spite of educational expansion, the decline of inequality of educational opportunity in schools and the institutional reforms in vocational training and university education, access to university education still remains remarkably unequal across social classes. According to the 'diversion thesis' suggested by Muller and Pollak, which was extended by Hillmert and Jacob, working-class children are distracted from the direct path to university by non-academic educational institutions which affect individuals' educational choices and provide attractive of education and training alternatives in non-academic areas. To investigate why such a diversion occurs, the mechanisms of socially selective educational choices have to be analyzed from the perspective of rational action theory. In order to test this theoretical approach, data of school leavers that have attained the 'Abitur' (high school degree) were collected in East Germany's federal state of Saxony. The main mechanisms responsible for the fact that working-class children are very likely to favour vocational training over education at university are the subjective evaluation of prior educational performance, the probability of success at university, and the subjectively expected costs. In particular, working-class children's educational choices are most influenced by negative estimates of prospective success in university education, which causes them to refrain from university education.

Delimited Stroke Oriented Algorithm-Working Principle and Implementation for the Matching of Road Networks

With the increasing availability of diverse geospatial databases, data integration becomes an indispensable process to assure the quality and add values to each single data source as well as promote the interoperability among different data sources. The paper presents an operational automatic matching approach for road networks based on the Delimited Stroke Oriented (DSO) algorithm. It consists of four processes: (1) establishment of an index to record the relationship between conjoint objects; (2) construction of the delimited strokes; (3) matching between the corresponding delimited strokes; and (4) matching growing from seeds. With the help of index, the conjoint edges to a delimited stroke can be easily brought together. The corresponding network is then treated as an integral unit in the matching process. As compared with point- or line-based matching, such as Buffer Growing (BG) and Iterative Closest Point (ICP), the network matching allows the consideration of more topological information in a larger context environment. Consequently, the DSO algorithm is able to yield a considerably improved matching performance in terms of computing speed, matching rate, matching certainty and robustness. The approach has been successfully tested on large road networks from a number of federal states in Germany.

What Companies do not Know About Self‐assessment: Self‐assessment in Germany

In Germany Quality Management awards and thus self‐assessment are well known and popular – at least amongst quality management professionals. About 2000 companies have carried out self‐assessment using the EFQM Model as a framework (DGQ, 2005). This is at least approximately the number of participants in German regional and national quality awards. Since 1992, with the first call for the national Ludwig‐Erhard‐Preis, about 1953 companies have taken part in a quality award, see figure (1). The number of participants varies from state to state. This difference may be caused by the application format: There are many applicants where the application is done by the means of a questionnaire, as it is the case of Bavaria (910), Thuringia (402), Northrhein‐Westphalia (267) and Saxony‐Anhalt (60). Fewer applications were received in Berlin‐Brandenburg (65), Saxony (84), Schleswig‐Holstein (40), and with the national quality award (125), where a demanding application brochure is needed. Number of participants and type of application format in quality awards of different federal states of Germany. Information on number of participants was collected from quality award offices.

Evaluation of a Diabetes Management System Based on Practice Guidelines, Integrated Care, and Continuous Quality Management in a Federal State of Germany

The aim of this study was to evaluate the Saxon Diabetes Management Program (SDMP), which is based on integrated practice guidelines, shared care, and integrated quality management. The SDMP was implemented into diabetes contracts between health insurance providers, general practitioners (GPs), and diabetes specialized practitioners (DSPs) unified in the Saxon association of Statutory Health Insurance Physicians. The evaluation of the SDMP in Germany represents a real-world study by using clinical data collected from participating physicians. Between 2000 and 2002 all DSPs and about 75% of the GPs in Saxony participated. Finally, 291,771 patients were included in the SDMP. Cross-sectional data were evaluated at the beginning of 2000 (group A1) and at the end of 2002 (group A2). A subcohort of 105,204 patients was followed over a period of 3 years (group B). The statewide implementation of the SDMP resulted in a change in therapeutic practice and in better cooperation. The median A1C at the time of referral to DSPs decreased from 8.5 to 7.5%, and so did the overall mean. At the end, 78 and 61% of group B achieved the targets for A1C and blood pressure, respectively, recommended by the guidelines compared with 69 and 50% at baseline. Patients with poorly controlled diabetes benefited the most. Preexisting regional differences were aligned. Integrated care disease management with practicable integrated quality management including collaboration between GPs and specialist services is a significant innovation in chronic care management and an efficient way to improve diabetes care continuously.

German Diabetes Disease Management Programs Are Appropriate for Restructuring Care According to the Chronic Care Model

With the introduction of diabetes disease management programs (DMPs) in Germany, there is a necessity to evaluate whether patients receive care that is congruent to the Chronic Care Model (CCM) and evidence-based behavioral counseling. We examined differences as perceived and experienced by patients with type 2 diabetes between those enrolled in a DMP compared with patients receiving usual care in two federal states of Germany. A random, heterogeneous sample of 3,546 patients (59.3% female) received a mailed questionnaire from their regional health fund, including the German version of the Patient Assessment of Chonic Illness Care (PACIC) instrument, which had additional items for behavioral advice (5A). Two weeks later, a general reminder was sent out. A total of 1,532 questionnaires were returned (response rate 42.2%), and valid data could be obtained for 1,399 patients. Mean age of responders was 70.3 years, of which 53.6% were female. Overall, patients enrolled in a DMP scored significantly higher (3.21 of a possible 5) than patients not enrolled in a DMP (2.86) (P < 0.001). Significant differences in the same direction were found on all five subscales of the PACIC. For the 5A scales, similar differences were found for all five subscales plus the sum score (P < 0.001; mean for DMP = 3.08, mean for non-DMP = 2.78). DMPs, as currently established in primary care in Germany, may impact provided care significantly. The changes in daily practice that have been induced by the DMPs are recognized by patients as care that is more structured and that to a larger extent reflects the core elements of the CCM and evidence-based counseling compared with usual care.

Uncertainty analysis of climate change mitigation options in the forestry sector using a generic carbon budget model

Industrialized countries agreed on a reduction of greenhouse gas emissions under the Kyoto Protocol. Many countries elected forest management activities and the resulting net balance of carbon emissions and removals of non-CO 2 greenhouse gases by forest management in their climate change mitigation measures. In this paper a generic dynamic forestry model (FORMICA) is presented. It has an empirical basis. Several modules trace C pools relevant for the Kyoto Protocol and beyond: biomass, litter, deadwood and soil, and harvested wood products. The model also accounts for the substitution of fossil fuels by wood products and bioenergy. FORMICA was used to first study the model sensitivity and uncertainty based on data from Thuringia, a federal state of Germany, to determine the major sources of uncertainty in carbon accounting at different levels of carbon pool aggregation (biomass, ecosystem, forestry sector and enhanced forestry sector including the accumulated substitution effect). Rotation length and maximum increment contributed most to uncertainty in biomass. The influence of the latter did not diminish with higher level of pool aggregation. Uncertainty in the enhanced forestry sector was to a smaller degree controlled by product and substitution related parameters. Relative uncertainty decreased with the level of aggregation and comprehensiveness of the carbon budget. In a second step the model estimated the sink potential of the Thuringian forestry sector. The projected average biomass sink for the period of 2003–2043 of 0.6 t C ha −1 year −1 could be increased by 50% by broadening the perspective to the entire forestry sector, including substitution effects. A simulation of forest conservation on 20% of the forest area increased C fixation. However, even in the biomass C pool the expected C stock changes did not exceed the estimated uncertainty of 40%. A higher level of aggregation (i.e. the inclusion of soil and litter, product pool and substitution effects) decreases relative uncertainty but also diminishes differences between different management options. The analysis demonstrates that the choice of management mitigation options under an accounting scheme should include the impacts on forest products and of substitution effects.

What Companies do not Know About Self‐assessment : Self‐assessment in Germany

In Germany Quality Management awards and thus self‐assessment are well known and popular‐at least amongst quality management professionals. About 2000 companies have carried out self‐assessment using the EFQM Model as a framework (DGQ, 2005). This is at least approximately the number of participants in German regional and national quality awards. Since 1992, with the first call for the national Ludwig‐Erhard‐Preis, about 1953 companies have taken part in a quality award, see figure (1). The number of participants varies from state to state. This difference may be caused by the application format: There are many applicants where the application is done by the means of a questionnaire, as it is the case of Bavaria (910), Thuringia (402), Northrhein‐Westphalia (267) and Saxony‐Anhalt (60). Fewer applications were received in Berlin‐Brandenburg (65), Saxony (84), Schleswig‐ Holstein (40), and with the national quality award (125), where a demanding application brochure is needed. Figure 1. Number of participants and type of application format in quality awards of different federal states of Germany. Information on number of participants was collected from quality award offices.

Early emergency response by means of dispersion forecasting – emergency management of the Deutscher Wetterdienst in the context of national and international agreements

Abstract Based on results of the numerical weather forecast models; the DWD (Deutscher Wetterdienst, German Meteorological Service) is immediately able to calculate dispersion forecasts in the case of an emergency with an emission of radioactive inventory. This information is essential for the management of further countermeasures. There are legal agreements between the federal states of Germany and the Federal Government regulating the mutual aid. For the emergency preparedness system RODOS (Real Time Online Decision Support) the results of the numerical weather forecasts are provided and complemented by medium-range dispersion forecasts. In the framework of the German computer network IMIS (Integrated Measurement and Information System for the Surveillance of Radioactivity in the Environment) the results of trajectory calculations are presented graphically within 10 minutes, those from the LPDM (Lagrangian Particle Dispersion Model) forecasts within 30 minutes. In case of a nuclear emergency, global distribution of information via the WMO (World Meteorological Organization) communication system GTS is part of international agreements between IAEA (International Atomic Energy Agency) and WMO, thus giving the DWD a key role. The commitments of the DWD in managing nuclear emergencies in the framework of national and international agreements are presented, as well as internal emergency arrangements.

Nitrogen Accumulation in Forests. Exposure Monitoring by Mosses

At present, there is still little information on nitrogen (N) accumulation in forests contrasting with the crucial importance of N in forest ecosystems. This work analyzes the N bioaccumulation in mosses from forested areas from Lower Saxony and North Rhine-Westphalia (two of 16 federal states of Germany), the Weser Ems Region (part of Lower Saxony), and the Euro Region Nissa (covering the Czech Republic, Germany, Poland). The studies involved samples collected from 190 sites between 1998 and 2005. Different spatial scales and regional differences in land use were chosen to assess the factors affecting N bioaccumulation in forested areas. A continuous reduction of N bioaccumulation was found from Lower Saxony (a region where agriculture is most predominant) to North Rhine-Westphalia (mostly urban). The Weser Ems Region (an agricultural region) showed a higher N concentration in mosses than the Euroregion Nissa (a former industrial region). Statistical analyses performed at the different spatial scales revealed that the areas showing greater agricultural and livestock spatial densities favor N bioaccumulation in mosses. N concentration in mosses was moderately correlated with the N concentration in the leaves and needles of the surrounding trees. No significant relationships were found regarding the crown density of forest trees or N deposition estimations from a combination of atmospheric models and deposition measurements.