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Regionale Unterschiede der Inanspruchnahme von Präventionsleistungen in der ambulanten Versorgung
(2016)
Das Ziel dieser Studie war es die regionalen Unterschiede der Inanspruchnahme sekundärpräventiver Leistungen in Deutschland auf Kreisebene zu analysieren. Hierbei sollte eine Lücke in der deutschen Forschung geschlossen werden, indem neben individuellen Faktoren auch ökologische Faktoren durch einen Mehrebenenansatz einbezogen wurden. Auf ökologischer Ebene wurde die Effekte der regionalen sozialen Deprivation, der Urbanisierung und der Arztdichte der ambulanten Ärzte analysiert. Variablen auf Individualebene waren Geschlecht und Gesundheitsstatus.
In der Studie wurden drei verschiedene Datenbanken miteinander verknüpft. Zur Berechnung der regionalen sozialen Deprivation und der Urbanisierung wurden Daten von INKAR für alle 402 Kreise verwendet. Das Bundesarztregister lieferte die Datengrundlage zur Bestimmung der Arztdichte. Die Abrechnungsdaten aller Kassenärztlichen Vereinigungen nach § 295 SGB V lieferten die Zahlen für die Inanspruchnahme der spezifischen Präventionsangebote als auch für Geschlecht und Gesundheitsstatus. Hierdurch war es möglich eine Vollerhebung aller gesetzlich Krankenversicherten zwischen 50 und 55 Jahren durchzuführen, die 2013 einen Arzt aufgesucht haben (N = 6,6 Mio.). Die unabhängigen Variablen der regionalen sozialen Deprivation und Urbanisierung sowie die Kontrollvariable Gesundheitsstatus wurden mit Hilfe der Faktorenanalyse gebildet. Um die regionalen Unterschiede analysieren zu können, wurde eine hierarchische multivariate Regression durchgeführt.
Rund 80% aller sekundärpräventiven Leistungen wurden von Frauen in Anspruch genommen. Ein schlechterer Gesundheitsstatus war mit einer höheren Rate der Inanspruchnahme assoziiert. Die Ergebnisse weisen auf regionale Unterschiede hin, die sich nach Geschlecht unterscheiden wobei die unabhängigen Variablen nur kleine Effekte aufweisen. Entgegen der Hypothese war eine höhere regionale soziale Deprivation mit einer höheren Inanspruchnahme bei Männern und Frauen assoziiert. Urbanität war bei Männern positiv und bei Frauen negativ mit der Inanspruchnahme assoziiert. Die Interaktion beider Variablen hat keinen Effekt auf Männer aber einen negativen Effekt auf Frauen. Die Arztdichte wurde aus dem finalen statistischen Modell ausgeschlossen, da die Variable Multikollinearität aufwies.
Bisherige Theorien sind nicht in der Lage die Ergebnisse zu erklären, da sie bisherigen Forschungsergebnissen widersprechen. Zusätzliche Berechnungen legen die Schlussfolgerung nahe, dass die herrschenden Ost-West-Unterschiede zu einer Konfundierung der Ergebnisse geführt haben. Berücksichtigt man das Alter der Patienten, kann vermutet werden, dass die Sozialisation der Inanspruchnahme sekundärpräventiver Leistungen in der DDR bis heute das Gesundheitsverhalten beeinflusst. Allerdings sind weitere Forschungen notwendig um die Gründe für die regionalen Unterschiede der Inanspruchnahme sekundärpräventiver Leistungen besser zu verstehen.
A comprehensive typology of basic executive formats is presented and linked to a discussion of tradeoffs in the design of executive-legislative relations. The focus is on the tradeoffs between three goals: (1) programmatic parties, (2) identifiable cabinets and (3) issue -specific legislative coalitions. To include semi-presidentialism into the typology in a logically consistent manner, a heretofore neglected executive format has to be defined, which is labelled semi-parliamentarism. Based on a discussion of Australian states, it is argued that semi-parliamentarism has the potential to mitigate the trilemma.
Die politikwissenschaftliche Literatur unterscheidet zwei Grundtypen von Forschungsdesigns: x- und y-zentriert. Dieser Beitrag argumentiert, dass ein „kontrastives“ Forschungsdesign als dritter Grundtyp abgegrenzt werden sollte. Die drei Designs unterscheiden sich durch die Anzahl der betrachteten Theorien und dadurch, ob mehrere Theorien konkurrierend oder komplementär sind. Die typologische Abgrenzung des kontrastiven Designs verdeutlicht auch die Vor- und Nachteile x- und y-zentrierter Designs. Anhand verschiedener Beispielstudien (experimentell und nicht-experimentell, quantitativ und qualitativ) werden die Charakteristika der drei Designs sowie ihre Kombinationsmöglichkeiten herausgearbeitet. Darüber hinaus wird das kontrastive Design als verbindendes Element zwischen den quantitativen und qualitativen Forschungs-„Kulturen“ hervorgehoben.
The political science literature distinguishes two basic types of research designs: x- and y-centered. The article argues for the distinction of a third basic type: the "contrastive" design. The three designs differ in the number of relevant theories and in whether they see theories as competing or complementary. The typological differentiation of the contrastive research design helps to clarify the pros and cons of x- and y-centered designs. The article uses exemplary studies (experimental and observational, quantitative and qualitative) to illustrate the characteristics of the three designs as well as the possibilities of combining them. The contrastive design also constitutes a common element of the quantitative and qualitative research, "cultures".
An egalitarian approach to the fair representation of voters specifies three main institutional requirements: proportional representation, legislative majority rule and a parliamentary system of government. This approach faces two challenges: the under-determination of the resulting democratic process and the idea of a trade-off between equal voter representation and government accountability. Linking conceptual with comparative analysis, the article argues that we can distinguish three ideal-typical varieties of the egalitarian vision of democracy, based on the stages at which majorities are formed. These varieties do not put different relative normative weight onto equality and accountability, but have different conceptions of both values and their reconciliation. The view that accountability is necessarily linked to ‘clarity of responsibility’, widespread in the comparative literature, is questioned – as is the idea of a general trade-off between representation and accountability. Depending on the vision of democracy, the two values need not be in conflict.
An egalitarian approach to the fair representation of voters specifies three main institutional requirements: proportional representation, legislative majority rule and a parliamentary system of government. This approach faces two challenges: the under-determination of the resulting democratic process and the idea of a trade-off between equal voter representation and government accountability. Linking conceptual with comparative analysis, the article argues that we can distinguish three ideal-typical varieties of the egalitarian vision of democracy, based on the stages at which majorities are formed. These varieties do not put different relative normative weight onto equality and accountability, but have different conceptions of both values and their reconciliation. The view that accountability is necessarily linked to clarity of responsibility', widespread in the comparative literature, is questioned - as is the idea of a general trade-off between representation and accountability. Depending on the vision of democracy, the two values need not be in conflict.
Decentralizing for performance? A quantitative assessment of functional reforms in the German Lander
(2016)
In the last 10 years, the governments of most of the German Länder initiated administrative reforms. All of these ventures included the municipalization of substantial sets of tasks. As elsewhere, governments argue that service delivery by communes is more cost-efficient, effective and responsive. Empirical evidence to back these claims is inconsistent at best: a considerable number of case studies cast doubt on unconditionally positive appraisals. Decentralization effects seem to vary depending on the performance dimension and task considered. However, questions of generalizability arise as these findings have not yet been backed by more ‘objective’ archival data. We provide empirical evidence on decentralization effects for two different policy fields based on two studies. Thereby, the article presents alternative avenues for research on decentralization effects and matches the theoretical expectations on decentralization effects with more robust results. The analysis confirms that overly positive assertions concerning decentralization effects are only partially warranted. As previous case studies suggested, effects have to be looked at in a much more differentiated way, including starting conditions and distinguishing between the various relevant performance dimensions and policy fields.
This article explores the practice and political significance of politicians’ journeys to conflict zones. It focuses on the German example, looking at field trips to theatres of international intervention as a way of first-hand knowledge in policymaking. Paying tribute to Lisa Smirl and her work on humanitarian spaces, objects and imaginaries and on liminality in aid worker biographies, two connected arguments are developed. First, through the exploration of the routinized practices of politicians’ field trips the article shows how these journeys not only remain confined to the ‘auxiliary space’ of aid/intervention, but that it is furthermore a staged reality of this auxiliary space that most politicians experience on their journeys. The question is then asked, second, what politicians actually experience on their journeys and how their experiences relate to their policy knowledge about conflict and intervention. It is shown that political field trips enable sensory/affectual, liminoid and liminal experiences, which have functions such as authority accumulation, agenda setting, community building, and civilizing domestic politics, while at the same time reinforcing, in most cases, pre-existing conflict and intervention imaginaries.
Der Fall der Rachel Dolezal
(2016)
Die Amerikanerin Rachel Dolezal war bis ins Jahr 2015 als Afroamerikanerin bekannt. Als Aktivistin der National Association for the Advancement of Colored People setzte sie sich für die Rechte der afroamerikanischen Bevölkerung ein, lebte in einem schwarzen Umfeld und lehrte an einer Universität Afroamerikanische Studien. „I identify as black“ antwortete sie auf die Frage eines amerikanischen Fernsehmoderators, ob sie Afroamerikanerin sei. Ihre Kollegen und ihr näheres Umfeld identifizierten sie ebenfalls als solche. Erst, als regionale Journalisten auf sie aufmerksam wurden und ihre Eltern sich zu Wort meldeten, wurde deutlich, dass Dolezal eigentlich eine weiße Frau ist. Dolezals Eltern bestätigten dies, indem sie Kindheitsfotos einer hellhäutigen, blonden Rachel veröffentlichten. Dolezals Verhalten entfachte daraufhin eine rege mediale Diskussion über ihre Person im Kontext von Ethnizität und »Rasse«.
Die Verfasserin greift Dolezals Fall exemplarisch auf, um der Frage nachzugehen, ob ein Doing Race nach Belieben möglich ist. Darf sich Dolezal als schwarz identifizieren, obwohl sie keine afrikanischen Vorfahren hat? Welche gesellschaftliche Wissensvorräte schränken diese Wahl ein und welche Konsequenzen ergeben sich daraus? Anhand einer Diskursanalyse amerikanischer Zeitungsartikel geht die Verfasserin diesen Fragen nach. Hierbei werden »Rasse« und Ethnizität als soziale Konstruktionen, basierend auf dem Konzept von Stephen Cornell und Douglas Hartmann, betrachtet.
In the debate on how to govern sustainable development, a central question concerns the interaction between knowledge about sustainability and policy developments. The discourse on what constitutes sustainable development conflict on some of the most basic issues, including the proper definitions, instruments and indicators of what should be ‘developed’ or ‘sustained’. Whereas earlier research on the role of (scientific) knowledge in policy adopted a rationalist-positivist view of knowledge as the basis for ‘evidence-based policy making’, recent literature on knowledge creation and transfer processes has instead pointed towards aspects of knowledge-policy ‘co-production’ (Jasanoff 2004). It is highlighted that knowledge utilisation is not just a matter of the quality of the knowledge as such, but a question of which knowledge fits with the institutional context and dominant power structures. Just as knowledge supports and justifies certain policy, policy can produce and stabilise certain knowledge. Moreover, rather than viewing knowledge-policy interaction as a linear and uni-directional model, this conceptualization is based on an assumption of the policy process as being more anarchic and unpredictable, something Cohen, March and Olsen (1972) has famously termed the ‘garbage-can model’.
The present dissertation focuses on the interplay between knowledge and policy in sustainability governance. It takes stock with the practice of ‘Management by Objectives and Results’ (MBOR: Lundqvist 2004) whereby policy actors define sustainable development goals (based on certain knowledge) and are expected to let these definitions guide policy developments as well as evaluate whether sustainability improves or not. As such a knowledge-policy instrument, Sustainability Indicators (SI:s) help both (subjectively) construct ‘social meaning’ about sustainability and (objectively) influence policy and measure its success. The different articles in this cumulative dissertation analyse the development, implementation and policy support (personal and institutional) of Sustainability Indicators as an instrument for MBOR in a variety of settings. More specifically, the articles centre on the question of how sustainability definitions and measurement tools on the one hand (knowledge) and policy instruments and political power structures on the other, are co-produced.
A first article examines the normative foundations of popular international SI:s and country rankings. Combining theoretical (constructivist) analysis with factor analysis, it analyses how the input variable structure of SI:s are related to different sustainability paradigms, producing a different output in terms of which countries (developed versus developing) are most highly ranked. Such a theoretical input-output analysis points towards a potential problem of SI:s becoming a sort of ‘circular argumentation constructs’. The article thus, highlights on a quantitative basis what others have noted qualitatively – that different definitions and interpretations of sustainability influence indicator output to the point of contradiction. The normative aspects of SI:s does thereby not merely concern the question of which indicators to use for what purposes, but also the more fundamental question of how normative and political bias are intrinsically a part of the measurement instrument as such. The study argues that, although no indicator can be expected to tell the sustainability ‘truth-out-there’, a theoretical localization of indicators – and of the input variable structure – may help facilitate interpretation of SI output and the choice of which indicators to use for what (policy or academic) purpose.
A second article examines the co-production of knowledge and policy in German sustainability governance. It focuses on the German sustainability strategy ‘Perspektiven für Deutschland’ (2002), a strategy that stands out both in an international comparison of national sustainability strategies as well as among German government policy strategies because of its relative stability over five consecutive government constellations, its rather high status and increasingly coercive nature. The study analyses what impact the sustainability strategy has had on the policy process between 2002 and 2015, in terms of defining problems and shaping policy processes. Contrasting rationalist and constructivist perspectives on the role of knowledge in policy, two factors, namely the level of (scientific and political) consensus about policy goals and the ‘contextual fit’ of problem definitions, are found to be main factors explaining how different aspects of the strategy is used. Moreover, the study argues that SI:s are part of a continuous process of ‘structuring’ in which indicator, user and context factors together help structure the sustainability challenge in such a way that it becomes more manageable for government policy.
A third article examines how 31 European countries have built supportive institutions of MBOR between 1992 and 2012. In particular during the 1990s and early 2000s much hope was put into the institutionalisation of Environmental Policy Integration (EPI) as a way to overcome sectoral thinking in sustainability policy making and integrate issues of environmental sustainability into all government policy. However, despite high political backing (FN, EU, OECD), implementation of EPI seems to differ widely among countries. The study is a quantitative longitudinal cross-country comparison of how countries’ ‘EPI architectures’ have developed over time. Moreover, it asks which ‘EPI architectures’ seem to be more effective in producing more ‘stringent’ sustainability policy.
In 2002 Germany adopted an ambitious national sustainability strategy, covering all three sustainability spheres and circling around 21 key indicators. The strategy stands out because of its relative stability over five consecutive government constellations, its high status and increasingly coercive nature. This article analyses the strategy's role in the policy process, focusing on the use and influence of indicators as a central steering tool. Contrasting rationalist and constructivist perspectives on the role of knowledge in policy, two factors, namely the level of consensus about policy goals and the institutional setting of the indicators, are found to explain differences in use and influence both across indicators and over time. Moreover, the study argues that the indicators have been part of a continuous process of ‘structuring’ in which conceptual and instrumental use together help structure the sustainability challenge in such a way that it becomes more manageable for government policy.
Georg Büchner: Woyzeck
(2016)
Das Theater ist seit seiner Erfindung durch die Griechen mit dem Politischen und insbesondere mit der Staatsform der Demokratie verbunden. Entsprechend kann das Theater als außerschulischer politischer Lernort zum Besuch mit Schülerinnen und Schülern dienen. Ziel der vorliegenden Publikation ist es, Vorschläge zur unterrichtlichen Bearbeitung von Theaterstücken zu präsentieren, zur Auseinandersetzung mit den politischen Gehalten von theatralen Narrationen in der politischen Bildung wie im fächerübergreifenden Unterricht anzuregen und zum Besuch von Theateraufführungen im Rahmen der politischen Bildung zu ermutigen.