Suchergebnisse

This study investigates whether patient-reported characteristics of the medical home are associated with improved quality and equity of preventive care, advice on health habits, and emergency department use. We used adjusted risk ratios to examine the association between medical home characteristics and care measures based on the 2010 Medical Expenditure Panel Survey. Medical home characteristics are associated with 6 of the 11 outcome measures, including flu shots, smoking advice, exercise advice, nutrition advice, all advice, and emergency department visits. Educational and income groups benefit relatively equally from medical home characteristics. However, compared with insurance and access to a provider, medical home characteristics have little influence on overall disparities in care. In sum, our findings support that medical home characteristics can improve quality and reduce emergency visits but we find no evidence that medical home characteristics alleviate disparities in care.

The core of existing healthcare typologies is the public—private mix in the three areas of funding, provision and regulation of healthcare services. This article aims to contribute to the debate by adding 'healthcare access' as an important dimension for comparing healthcare systems. In contrast to previous analyses, I extend the concept of access by looking at regulative aspects and financial incentives that shape entry and reception of care. Based on empirical indicators for three different dimensions of healthcare access — gatekeeping, cost sharing and supply — a cluster analysis is performed that yields four access regime types: financial incentive states; strong gatekeeping/low supply states; weakly regulated/high supply states; and mixed regulation states. The countries clustered in the access regimes show a different pattern than typologies based on other system indicators. This suggests that previously used dimensions for comparison do not sufficiently capture patients' access to healthcare.

The study investigates whether sick leave for the unemployed is used to address problems of labour market integration – a process that can theoretically be conceptualised as the medicalisation of unemployment. Estimating a multilevel logistic regression model on a sample of N = 20,196 individuals from the German panel study Labour Market and Social Security (PASS) reveals that, on average, 18% of the unemployed are on sick leave due to poor health. However, given a comparable state of health, the probability increases for men, older individuals and those with lower educational levels. These findings are crucial as they reveal a dual role of sick leave in a context with limited access to disability pensions: as a protective measure for sick, unemployed individuals and as medicalisation of unemployment by excluding those who face non-medical barriers to labour market integration.

Der Datensatz "vig-mepyso-2w-raw" ist ein Rohdatensatz bestehend aus den gesammelten Daten zweier faktorieller Surveys des Forschungsprojektes "Medikalisierung und Psychologisierung sozialer Probleme – Chancen und Herausforderungen für Sozialpolitik (MEPYSO)". In zwei Befragungswellen (September 2019 und Dezember 2020-Januar 2021) wurden insgesamt N=5.150 Personen über das YouGov Panel Deutschland befragt. In der 1. Befragungswelle konnten dabei N=2.621 Personen rekrutiert werden, deren Antworten auf Basis eines Quotenstichprobenverfahrens auf Schlüsselvariablen wie Geschlecht, Alter, Bildung und Wohnort (Bundesland) repräsentativ für die gesamtdeutsche erwachsene Bevölkerung ist. In der 2. Befragungswelle konnten zudem N=1.843 Personen erneut rekrutiert werden (Recontact), die bereits in der 1. Welle teilgenommen hatten. Sowohl für das Gesamtsample 2020 als auch nur für das Recontact-Sample sind die Antworten ebenfalls repräsentativ für die gesamtdeutsche erwachsene Bevölkerung.
Neben der Erfassung standardisierter demographischer Variablen war der Kern der Befragung ein faktorieller Survey. In der ersten Befragungswelle wurden dabei den Befragten Fallbeschreibungen (sog. Vignetten) von Kindern mit Verhaltensauffälligkeiten bzw. klinischen Symptomatiken vorgelegt. Befragte konnten im Anschluss ihre Einschätzungen auf gestuften Likert-Skalen zu den folgenden Themenschwerpunkten abgeben: (1) Kausale Begründung für das Verhalten, (2) Handlungsempfehlungen für die Eltern und (3) Möglichkeiten der Gesellschaft zum Umgang mit den beschriebenen Kindern.
Darüber hinaus wurden in beiden Befragungswellen Vignetten von Personen vorgelegt, die arbeitslos sind. Aufbauend auf einer Vignettenstudie von Buss (2018; https://doi.org/10.1177/0958928718757684) haben wir zusätzlich eine chronische Erkrankung und speziell in der 2. Welle die Zugehörigkeit zu einer Risikogruppe für eine COVID-19-Erkrankung als Begründung für die Arbeitslosigkeit implementiert. Befragte konnten dann angeben, (1) wieviel Arbeitslosengeld I und II sie den Befragten zusprechen würden, (2) welche Voraussetzungen die beschriebenen Personen erfüllen müssen und (3) wie stark sie bei Fehlverhalten sanktioniert werden sollen.
Im Zuge der tiefgreifenden Veränderungen durch die Corona-Pandemie wurden die Befragten innerhalb der 2. Befragungswelle rund um die Themenschwerpunkte (1) Infektionsgeschehen, (2) Stigma, (3) Vertrauen in Institutionen und (4) Folgen der Krise befragt.

Zusätzliche Schlagwörter: Psychologisierung, Soziale Legitimität, Faktorieller Survey, Vignettenstudie

Active labour market policy (ALMP) reforms have fundamentally changed welfare states over the last decades. Their objectives are quite diverse: workfare reforms have increased conditionality and sanctioning of benefits, while enabling reforms have extended education and training opportunities for the unemployed. Little is known about the political discourse on ALMP reforms. We investigate how the individual unemployed person is portrayed in ALMP reforms via a comparative coding analysis of parliamentary debates on labour market reforms that took place in Germany in 2003 (workfare) and in 2016 (enabling). Our results indicate that compared to enabling reforms the individual unemployed is less important in the framing of workfare reforms but more often blamed. Party characteristics matter: parties on the left more often point to the deservingness of the unemployed. However, when the social democratic party in government introduced a workfare reform they used blaming of unemployed persons as a framing strategy.

Abstract
Mit der Veröffentlichung der Armuts- und Reichtumsberichte der Bundesregierung seit 2001 hat sich ein politischer Armutsdiskurs in Deutschland verstetigt. Gesundheit ist in allen bisherigen fünf Berichten eine zentrale Dimension. Jedoch ist für Deutschland bis heute wenig erforscht, welche Rolle Gesundheit in der politischen Debatte zu Armut einnimmt. Aufbauend auf der Medikalisierungstheorie untersuchen wir in diesem Beitrag mit einer qualitativen und quantitativen Inhaltsanalyse, wie Gesundheit und Krankheit in den Berichten dargestellt werden. Über den gesamten Zeitraum wird Armut eher als Ursache von Krankheit gesehen. Der Schwerpunkt der Lösungen für armutsbedingte Krankheiten liegt vor allem auf Verbesserungen des Gesundheitssystems und nicht bei der Armutsbekämpfung. Verhältnisprävention spielt erst in den letzten beiden Berichten eine bedeutsame Rolle. Auch werden gesundheitsbedingte Armutslagen nach dem vierten Armuts- und Reichtumsbericht (2013) weniger individualisiert und stattdessen strukturelle Ursachen wie Arbeitsbedingungen stärker diskutiert.

This paper investigates whether choice has gained importance as a political narrative and factually in care policies in Germany and the Netherlands since the late 1980s. Previous literature suggests that welfare reform introduced an increasing focus on choice in various policy areas in Bismarckian welfare states and beyond, but whether choice is a central aspect across different care policies is not well understood. We argue that choice is an important component for analysing change in family-related policies, because it reflects how much welfare states have moved towards supporting individualism in family arrangements. Moreover, economic as well as sociological research is interested in choice due to its association with quality of care and inequalities. By analysing maternity care policies alongside childcare policies, we also add a hitherto often neglected state intervention in family life, i.e. policies addressing pregnancy and childbirth.

Recent social science scholarship has argued that poverty is increasingly discussed as a problem that can have medical or psychological causes and could be tackled through therapeutic and health-related interventions. The aim of this study is to investigate if such a trend towards the medicalisation and psychologisation of poverty is present in the scientific poverty discourse. We analysed 13,553 articles on poverty in advanced, industrialised countries published between 1956 and 2017 and indexed in Web of Science. The results show that health sciences and psychology have been the fastest-growing research areas and the individual disciplines with currently the largest publication output on poverty.

Gatekeeping and provider choice have become central in health policymaking within the last two decades. This article contributes to the debates in two ways: first, it provides an extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and patient empowerment; and second, it empirically analyses regulations and identifies common trends in healthcare reforms in OECD countries since 1990. More than half of the countries analysed have established gatekeeping systems, while a smaller number provides free access to secondary care. The study discovers a trend towards strengthening gatekeeping regulations within free access countries. Free choice of provider is the standard in the OECD, where only a small number of countries restrict provider choice. The article identifies a diverging trend of reforms, with some traditionally restrictive countries offering more provider choice and other countries limiting the choice of providers as a result of managed care reforms.

Although some healthcare systems have introduced gatekeeping that forces patients to choose a general practitioner for a longer period, other systems rely on a free choice of doctors. This paper analyzes how these instruments affect differences in healthcare utilization in European countries. Using data from the first wave of the Survey of Health, Aging and Retirement, the authors investigate how access regulations affect a) the overall level of ambulatory healthcare usage, and b) disparities in utilization among groups with different educational and income levels. The data show that access regulation affects patients' decisions to see a doctor and reduces the extent of specialist healthcare used. Cost sharing could not be related to inequities among income groups; however, gatekeeping has favorable effects on reducing inequality, and the respective healthcare systems show lower levels of inequality among groups with different levels of education.