Utilities In Germany Research Articles

Inequality in health care utilization in Germany? Theoretical and empirical evidence for specialist consultation

In view of increasing concern about a two-class system in the German health care sector, this study investigates the relevance of health insurance schemes and other socioeconomic characteristics to the level of specialist health care provision. Referring to Ronald M. Andersen’s model of health care utilization and more content-based approaches, we implement a negative binomial hurdle regression to estimate the number of specialist visits within the last 12 months. Our data source is the German sample of the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) in 2004. The results show that men’s number of specialist visits is markedly sensitive to predisposing and enabling factors, whereas women’s health care utilization depends less on such socioeconomic characteristics. With reference to previous findings concerning general practitioner consultation, the assumption of a bipolar health care system providing general practitioner care primarily to the statutory insured and specialist care to the privately insured is supported empirically as to men. Education, which is considered to be highly correlated with health lifestyles, has a positive effect on medical health care. Every additional year of education increases by about 10% the probability of men seeking specialist consultation. Furthermore, the results indicate an unfavorable situation for the self-employed concerning health care because of their specific employment situation and health insurance coverage. The research results suggest the existence of relevant differences in the amount of specialist consultation according to health insurance and other socioeconomic features. Further research could concentrate on the question of whether these inequalities in utilization levels indicate overprovision or underprovision of ambulant health care. Moreover, we recommend longitudinal research that is particularly suited to detangle age and cohort effects.

Invasion biology and host specificity of the grapevine yellows disease vector Hyalesthes obsoletus in Europe

AbstractWithin the past 10 years, the yellows disease ‘bois noir’ (BN) has become one of the commercially most important diseases of grapevine [Vitis vinifera L. (Vitaceae)] in Europe. Infection pressure is caused by phytoplasmas of the stolbur 16SrXII‐A group that are transmitted by a planthopper vector, Hyalesthes obsoletus Signoret (Homoptera: Auchenorrhyncha). Infestation happens as an accidental side‐effect of the feeding behaviour of the vector, as vector and pathogen proliferation is dependent on other plants. In Germany, the increase of BN is correlated with the use of a new host plant by the vector, increase in abundance of the vector on the new host plant, and dissemination of host plant‐specific pathogen strains. In this article, we investigate geographic and host‐associated range expansion of the vector. We test whether host‐plant utilization in Germany, hence the increase in BN, is related to genetic host races of the vector and, if so, whether these have evolved locally or have immigrated from southern populations that traditionally use the new host plant. The genetic population analysis demonstrates a recent expansion and circum‐alpine invasion of H. obsoletus into German and northern French wine‐growing regions, which coincides with the emergence of BN. No H. obsoletus mitochondrial DNA haplotype host‐plant affiliation was found, implying that the ability to use alternative host plants is genetically intrinsic to H. obsoletus. However, subtle yet significant random amplified polymorphic DNA (RAPD) genetic differentiation was found among host plant populations. When combined, these results suggest that a geographic range expansion of H. obsoletus only partly explains the increase of BN, and that interactions with host plants also occur. Further possible beneficial factors to H. obsoletus, such as temperature increase and phytoplasma interactions, are discussed.

Technical and economic aspects of waste heat utilization

The main aim of the following presentation is the comparison and evaluation of the conditions for waste heat utilization in Germany and in Poland. This paper presents synthetically the results of economic analysis of the different technical variants. The employment of heat pumps and other heat transformers, respectively, can reduce the energy consumption, but using of those technical possibilities depends mainly on the economic aspects. The main parameters of the financial calculations were the energy and equipment costs but beyond it a number of other factors were also considered and compared, for example calculation interests, profit tax level and similar. Four different technical alternatives were analyzed, it is using of absorption heat pump, compression heat pump, heat transformer (absorption), and a special combined system with gas motor to drive of heat pump compressor. The capital value as main result of the investigations is in Poland generally lower because of relatively high investment cost and lower energy prices compared to the situation in Germany and West Europe. The basis for the presented comparative analysis was an industrial project in Germany which effected in development of concepts for waste heat using. .

Theory matters! Efficiency measurement and water utilities

As is the case of other infrastructure sectors the availability of efficiency estimation software based on statistical inference – freely distributed via the internet and relatively easy to use – recently inflated the number of corresponding applications in the water sector. The robustness of regulatory measures based on inferences from efficiency measures nevertheless crucially depends on theoretically well-founded estimates. This is illustrated by using an empirical example of an inconsistent technical efficiency frontier for water utilities in Germany.

The history of waste energy recovery in Germany since 1920

The history of waste energy utilization in Germany during the 20th century is the story of alternately significant developments and significantly missed opportunities. In spite of three waves of remarkable progress during this period, there were economic, political, scientific and societal obstructions which prevented further development and implementation of this promising energy resource.

Current state of wood-energy utilization in Germany

Current state of wood-energy utilization in Germany

Accident Flying Squad

Background and Aims: Cost increases in the healthcare system are leading to a need to distribute financial resources in accordance with the value of each service performed. Health-economic decision-making models can support these decisions. Due to the previous unavailability of health utilities in Germany (scored states of health as a basis for calculating quality-adjusted life-years, QALYs) for women undergoing treatment, international data are often used for such models. However, these may widely deviate from the values for a woman actually living in Germany. It is, therefore, necessary to collect and analyze health utilities in Germany. Materials and Methods: In a questionnaire survey, health utilities were collected, along with data for a healthy control group, for 580 female patients receiving treatment in the fields of mastology and gynecological oncology using a German version of the EuroQol questionnaire (EQ-5D) and a visual analogue scale (VAS). Data were also collected for the patients9 medical history, tumor disease, and treatment. Results: Significant differences with regard to quality of life were measured in relation to the individual tumor entities and in comparison to the controls. Apart from the healthy control group, patients with breast or cervical carcinoma had the best quality of life. In patients with recurrent and metastatic disease, those with breast carcinoma experienced the greatest impairment of their quality of life. According to current treatment, the most important impairment of life quality occurred in patients under radiotherapy and after surgical treatment. There are significant differences from the health utilities recorded for other countries – for example, the state of health declines much more markedly in patients with metastatic disease among American women with breast carcinoma than among German women, in whom recurrent disease and a first diagnosis of metastasis were comparable. Overall, the VAS was able to distinguish more adequately than the EQ-5D questionnaire between the different situations and impairments resulting from diagnosis and therapy. Conclusion: Health utilities are now, for the first time, available for further health-economics analyses in the field of gynecological oncology and mastology for women living in Germany. Important differences in these utilities from those of other countries are evident.