Juliane F. Stahl

Integrated Care Experiences And Outcomes In Germany, The Netherlands, And England

Care for people with chronic conditions is an issue of increasing importance in industrialized countries. This article examines three recent efforts at care coordination that have been evaluated but not yet included in systematic reviews. The first is Germanys Gesundes Kinzigtal, a population-based approach that organizes care across all health service sectors and indications in a targeted region. The second is a program in the Netherlands that bundles payments for patients with certain chronic conditions. The third is Englands integrated care pilots, which take a variety of approaches to care integration for a range of target populations. Results have been mixed. Some intermediate clinical outcomes, process indicators, and indicators of provider satisfaction improved; patient experience improved in some cases and was unchanged or worse in others. Across the English pilots, emergency hospital admissions increased compared to controls in a difference-in-difference analysis, but planned admissions declined. Using the same methods to study all three programs, we observed savings in Germany and England. However, the disease-oriented Dutch approach resulted in significantly increased costs. The Kinzigtal model, including its shared-savings incentive, may well deserve more attention both in Europe and in the United States because it combines addressing a large population and different conditions with clear but simple financial incentives for providers, the management company, and the insurer.

Convergence or Divergence? Educational Discrepancies in Work-Care Arrangements of Mothers with Young Children in Germany:

This study examines how educational differences in work-care patterns among mothers with young children in Germany changed between 1997 and 2013. Since the mid-2000s, Germany has undergone a paradigm shift in parental leave and childcare policies. Our comparative analysis of East and West Germany provides new evidence on whether the long-standing gender regime differences interact with recent developments of social class inequalities in the changing family policy context. The analyses include pooled binary and multinomial logistic regressions based on 17,764 observations of 8604 children below the age of three years from the German Socio-Economic Panel Study (SOEP). The findings point to growing educational divergence in work-care arrangements in East and West Germany: employment and day-care use increased more strongly among families with medium and highly educated mothers compared to those with low education. This has critical implications for the latter’s economic security. The decline in the use of informal childcare options was, however, fairly homogenous.

Early Childhood Education and Care Quality in the Socio-Economic Panel (SOEP) – the K2ID-SOEP Study

Since 2000, Germany is experiencing an expansion of early childhood education and care (ECEC) institutions for children younger than three as well as increasing availability of full-day care for children aged three or older. More and more children attend ECEC centres for increasingly longer hours. Thus, ECEC centres are becoming an increasingly important environment for children and their parents. Given this background, an increasing number of economists are working on issues related to ECEC – with respect to either parental labour force participation or child outcomes. The K2ID-SOEP data sets are of particular interest to these researchers – and to all other social scientists investigating the impact of early childhood education and care across a variety of domains.The Socio-Economic-Panel Study (SOEP), as the largest and longest running multidisciplinary household panel in Germany (Wagner et al. 2007), started collecting information on ECEC centre attendance since its first wave in 1984. Irregularly, the SOEP collects information on the costs for ECEC care and the provider type. To learn more about the institutional context of ECEC, the aim of a larger research and data project funded by the Jacobs Foundation was to collect information from ECEC centres that are attended by children in the SOEP. Moreover this information of an institution survey was combined with the individual data of the SOEP. 1 This approach, which takes individual data as a starting point, differs from other data sets that collect comparable information in ECEC centres, such as the National Education Panel Study (NEPS), NEPS-starting cohort 2 (e. g. Blossfeld et al. 2011), which started with a sample of ECEC centres and planned to followed all children in the centres. The main aim of our K2ID-SOEP study (short: K2ID-SOEP) was to collect information on the quality of ECEC centres of all SOEP children in such centres. ECEC quality is a key feature that affects child development and other parental outcomes, such as parental employment and parental wellbeing (see e. g., Schober et al. 2016; Anders 2013). The K2ID-SOEP study was realized between 2013 and 2015. K2ID is an acronym for ‘Kinder und Kitas In Deutschland’ (‘Children and Childcare Centres in Germany). The K2ID-SOEP study encompasses two surveys, a Parent Survey and an Institution Survey.