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Desmet and Ortın analysed regional development using a Ricardian model theory. This paper uses their framework. The authors analyse the influence of wage subsidization, unemployment benefit, public employment management, consideration of the demographic factor and asymmetric value of the input factor labor on the development of regional inequalities between regions. By reducing the labor in the Ricardian model framework, the input factor can be reduced. The lower input factor labor leads to a reduction in the world market supply and to lower production, which in turns to decline in prosperity. Practical relevance results from the effects of external shocks such as unemployment benefits or demographic aspects. Both aspects reduce the labor population (asymmetric distribution of the input factor labor). This damages the advanced region rather than the underdeveloped region.

Zusammenfassung Einleitung Seit 1. Januar 2004 sind alle an der vertragsärztlichen Versorgung teilnehmenden Ärzte, Psychotherapeuten und medizinische Versorgungszentren nach § 135a Absatz 2 Nr. 2 des Fünften Sozialgesetzbuches verpflichtet, einrichtungsintern ein Qualitätsmanagementsystem einzuführen und weiterzuentwickeln. Die Ärzte stehen vor der Frage, welches Qualitätsmanagementsystem für die eigene Praxis geeignet ist. Methodik Insgesamt wurden 24 Arztpraxen per Zufallsstichprobe ausgewählt. Die Stichprobe wurde im Bundesland Sachsen erhoben, weil die Kassenärztliche Vereinigung Sachsen die notwendigen Informationen bereitstellt. Zuerst erfolgte die Bestimmung von 2 Primäreinheiten aus der Grundgesamtheit. Im Folgeschritt wurde für jede Primäreinheit eine Stichprobe über 3 Qualitätsmanagementsysteme gezogen. Die einzelnen Fragen wurden unabhängig von einem Qualitätsmanagementsystem entwickelt. Die Basis bildeten die Vorgaben der Richtlinie des Gemeinsamen Bundesausschusses, welche die konkreten Inhalte der Qualitätskategorien beschreibt. Insgesamt liegen in den 3 Befragungsgruppen 26 Qualitätskategorien mit verschiedenen Fragen vor. Zur Analyse der Daten wird in den einzelnen Fragenkomplexen das arithmetische Mittel gebildet. Anschließend wird mittels einer Varianzanalyse getestet, ob sich die Qualitätsmanagementsysteme im Mittel statistisch signifikant unterscheiden. Unter Beachtung der Kosten der einzelnen Qualitätsmanagementsysteme und deren Einführung wird die Effektstärke nach η2 und Cohenʼs d analysiert. Abschließend erfolgt eine Kosten-Nutzen-Analyse, indem durch ein Literaturstudium die direkten/ indirekten Kosten der verschiedenen Systeme recherchiert wurden. Ergebnisse Beim „Qualität und Entwicklung in Praxen (QEP)“ liegen anhand von Musterdokumenten und Prozessunterstützungen die höchste Bewertung vor. Aufgrund einer spezifischen Hausarztausrichtung folgt mit guten Bewertungen „Qualität in sächsischen Arztpraxen (QisA)“. Die einzelnen Qualitätskategorien wie ‚Leistungsspektrum‘ oder ‚Erkrankungsspezifische Maßnahmen‘ weisen signifikante Unterschiede sowie nachhaltige Effektstärken zwischen den Systemen auf und führen zur sehr guten Bewertung beim QEP. Schlussfolgerung Die Bewertungen der Qualitätsmanagementsysteme weisen signifikante Unterschiede auf. Weiterhin wird eine sehr hohe Effektstärke dargelegt. Die konkreten Unterschiede zwischen den Qualitätsmanagementsystemen sind durch Unterschiede in der Unterstützung von Prozessbeschreibungen sowie Musterdokumenten zu erklären.

Desmet, Gumpert, and Ortίn have analyzed regional development using the Ricardian model, Heckscher-Ohlin theorem or the core peripheral model. However, how the individual assumptions behave with each other (capital transfers to the number of companies or utility values) or in combination (combined wages) has so far been completely ignored. The paper shows a new internal model of rational underdevelopment. Several factors such as labor and capital after Heckscher-Ohlin; and combination wages, substitution elasticity, marginal costs, fixed costs, variable costs, transportation costs, distribution of companies, and company volumes after core peripheral model are considered. The advanced region continues to develop with the ‘extended’ core peripheral model. Without the return transfer, the highest increase in utility would be recorded in the advanced region, because the two factors as well as the ‘extended’ core peripheral model (cost optimization measures) increase the utility. From the findings of the Heckscher-Ohlin theorem, it is known that capital transfers actually help the underdeveloped region in its development and reduce inequality between the two regions. Thus the advanced and underdeveloped region has a model-theoretical incentive for the ’extended’ core peripheral model. The disadvantages of both initial models are overcome and added value is created for both regions.

The following article analyzes why an extension of the core-peripheral model is necessary for realistic economic use. The starting point is the core-peripheral model from Krugman. Various modifications are then made to make the Krugman model more robust, growth-oriented, and realistic. The models by Ricardian, Heckscher-Ohlin, Krugman, and Solow are combined by the author. This new model provides a general explanation model that is advantageous for the most diverse analyses that is, from rigid to dynamic, and growth theory-oriented model frameworks. The Ricardian model provides an immobile factor of work, perfect competition, distribution-free productions, comparative cost advantages, and constant economies of scale. The Heckscher-Ohlin theorem provides a second mobile input factor capital and production functions according to the equipment of the regions. The core-peripheral model provides aspects of monopolistic competition, cost functions, transportation costs, and spatial distribution. Depreciation rates, investment rates, and savings rates are taken over from the Solow model. We define the following parameters in the new model variant: reasons for model expansion, input factors, technology components, transportation costs, investment rate, savings rate, outputs, number of business/distribution, cost functions, consumer benefits, goods prices, wages, returns, and incomes., peer-reviewed

Desmet, Gumpert, and Ortίn have analyzed regional development using the Ricardian model or the Heckscher–Ohlin theorem. However, aspects such as consideration of combined wages, substitution elasticities, marginal costs, fixed costs, and number of companies were completely ignored. This study investigates the underdevelopment of regions in light of Krugman`s core–peripheral model. The extension of the model is intended to analyze the aspects that have so far been ignored and their influence on the benefits of the two regions. The following aspects characterize the model. Two regions with two sectors are considered for the model. The regions are characterized by different technological equipment. The first region is industrial. The second region has an agricultural character. When a new technology is available, both regions can benefit under certain conditions. The financial transfers lead to a convergence of wages.

Since 1 January 2004, all physicians, psychotherapists and medical care centres on contracts with statutory healthcare in Germany are obliged according to § 135a section 2, no. 2 of the Fifth Social Security Statute Book to introduce and develop an intra-institutional quality management system. Thus, physicians are faced with the question of which quality management system is best suited to their own practice.A total of 24 medical practices were chosen by random sampling. The sample was collected in Saxony because the Health Insurance Physicians Unification Saxony provided the necessary information. First, 2 primary units were determined from the basic population. In the following step, a sample was taken for each primary unit using 3 quality management systems. The analysis was carried out with the help of three specially developed questionnaires (physician, employee and patient). The individual questions were developed independently of a quality management system. The basis was formed by the guidelines of the Federal Joint Committee, which describes the concrete contents of the quality categories. A total of 26 quality categories with different questions were available in the 3 survey groups. For the analysis of the data, the arithmetic mean was formed in the individual question complexes. Subsequently, a variance analysis was used to test whether the systems differed statistically significantly on average. Taking into account the costs of the individual quality management systems and their introduction, the effect size was finally analyzed according to η2 and Cohen's d. Finally, a cost-benefit analysis was carried out by researching the direct/indirect costs of the various quality management systems through a literature study.Based on model documents and process support, the "Quality and Development in Practices" had the highest score. Due to a specific family practitioner specialty, "Quality management systems in Saxony medical practices" had the next best scores. The individual quality categories such as the 'range of services' or 'treatment pathways and guidelines' indicate significant differences and sustained effect sizes between quality management systems.The assessment of quality management systems shows significant differences. The specific differences between the systems can be explained by the differences in process tools.Seit 1. Januar 2004 sind alle an der vertragsärztlichen Versorgung teilnehmenden Ärzte, Psychotherapeuten und medizinische Versorgungszentren nach § 135a Absatz 2 Nr. 2 des Fünften Sozialgesetzbuches verpflichtet, einrichtungsintern ein Qualitätsmanagementsystem einzuführen und weiterzuentwickeln. Die Ärzte stehen vor der Frage, welches Qualitätsmanagementsystem für die eigene Praxis geeignet ist.Insgesamt wurden 24 Arztpraxen per Zufallsstichprobe ausgewählt. Die Stichprobe wurde im Bundesland Sachsen erhoben, weil die Kassenärztliche Vereinigung Sachsen die notwendigen Informationen bereitstellt. Zuerst erfolgte die Bestimmung von 2 Primäreinheiten aus der Grundgesamtheit. Im Folgeschritt wurde für jede Primäreinheit eine Stichprobe über 3 Qualitätsmanagementsysteme gezogen. Die einzelnen Fragen wurden unabhängig von einem Qualitätsmanagementsystem entwickelt. Die Basis bildeten die Vorgaben der Richtlinie des Gemeinsamen Bundesausschusses, welche die konkreten Inhalte der Qualitätskategorien beschreibt. Insgesamt liegen in den 3 Befragungsgruppen 26 Qualitätskategorien mit verschiedenen Fragen vor. Zur Analyse der Daten wird in den einzelnen Fragenkomplexen das arithmetische Mittel gebildet. Anschließend wird mittels einer Varianzanalyse getestet, ob sich die Qualitätsmanagementsysteme im Mittel statistisch signifikant unterscheiden. Unter Beachtung der Kosten der einzelnen Qualitätsmanagementsysteme und deren Einführung wird die Effektstärke nach η2 und Cohenʼs d analysiert. Abschließend erfolgt eine Kosten-Nutzen-Analyse, indem durch ein Literaturstudium die direkten/ indirekten Kosten der verschiedenen Systeme recherchiert wurden.Beim „Qualität und Entwicklung in Praxen (QEP)“ liegen anhand von Musterdokumenten und Prozessunterstützungen die höchste Bewertung vor. Aufgrund einer spezifischen Hausarztausrichtung folgt mit guten Bewertungen „Qualität in sächsischen Arztpraxen (QisA)“. Die einzelnen Qualitätskategorien wie ‚Leistungsspektrum‘ oder ‚Erkrankungsspezifische Maßnahmen‘ weisen signifikante Unterschiede sowie nachhaltige Effektstärken zwischen den Systemen auf und führen zur sehr guten Bewertung beim QEP.Die Bewertungen der Qualitätsmanagementsysteme weisen signifikante Unterschiede auf. Weiterhin wird eine sehr hohe Effektstärke dargelegt. Die konkreten Unterschiede zwischen den Qualitätsmanagementsystemen sind durch Unterschiede in der Unterstützung von Prozessbeschreibungen sowie Musterdokumenten zu erklären.

In previous analyses of regional underdevelopment, aspects such as technological progress, the implications of growth theory, depreciation (especially capital), capital input, and technology input have been completely ignored. Desmet and Ortίn analyze rational underdevelopment using a Ricardian model. This study investigates the underdevelopment of regions in the light of the Solow model. Two regions with two sectors are considered for the model. The regions are characterized by different technological equipment. The first region is industrial. The second region has an agricultural character. When a new technology is available, both regions can benefit under certain conditions. Financial transfers between regions equalize incomes. The security of transfer payments is positive; the increase in income levels without an increase in productivity is negative. The regions have different depreciation rates, factors, and technology endowments. Enlargement to a growth theoretical model framework (Solow model) should demonstrate the effects of an economy’s investments, constant depreciation rates, population growth, and technological progress. This will make it possible to see how the new influencing factors influence the utility of the two regions.

According to Sect. 135a (2) of the Fifth Book of the German Social Code (SGB V), all physicians, psychotherapists and medical care centers are obliged to introduce an intra-institutional quality management system (QM system). The legislator instructed the Federal Joint Committee (G-BA) to develop basic requirements in a quality management guideline (QM-RL). Factor analysis was used to examine whether individual quality categories had a significant influence on the scores of QM systems.The random sample was collected in Saxony and included a total of 24 medical practices because these practices were made available for analysis by the Saxon Association of Statutory Health Insurance Physicians. First, two primary units (family physicians/specialists) were established from the population. In the following step, one sample per QM system was drawn for each primary unit. In total, there were twelve family physicians and twelve specialists, or eight practices per QM system. The analysis was performed using three self-constructed questionnaires (physician, employee and patient). The individual items were developed independently of a QM system (26 quality categories with 40 questions per survey group). For the analysis, the arithmetic mean was calculated in the individual groups of questions. Factor analysis was used to investigate which quality categories per QM system had a significant influence on the evaluations. The Kaiser-Meyer test was used to measure the data's suitability for factor analysis, also Bartlett's test relating to significance and the cumulative percentage of total of variance were applied.In the first step, the quality categories having a significant influence on the overall evaluation of the QM system are presented. Regarding the DIN EN ISO 9001, 18 quality categories have a significant influence on the overall result; in QEP and QisA, 17 quality categories each have a significant influence on the overall result. The quality categories 'continuous professional development and qualification', 'hygiene and cleaning', 'quality management system', 'quality objectives', and 'procurement and storage' do not define an influence on the overall rating in any of the QM systems. Finally, eleven relevant quality categories were discovered which have an influence on all the QM systems.17 quality categories have a significant influence on the overall rating based on sample documents, flow charts, process flows, interview guidelines, maintenance protocols, or job advertisements. There are also eleven categories with a significant and pronounced effect on all three QM systems.

This paper analyzes how differences in regional development arise through technological variations and changes. Previous Ricardian-model-based considerations of this phenomenon, known as rational underdevelopment, have ignored migration, elasticities, multidimensional factors and inputs. This study thus re-examines rational underdevelopment in light of the Heckscher-Ohlin Theorem, considering two regions, with two sectors, in two periods. The regions have different factor and technology endowments. The first region has a technology sector, and the second is a technology laggard. Once a new technology that can potentially benefit both regions is introduced, the technology-endowed region offers financial transfers to the technologically lagging region. This equalizes regional incomes but also reduces the possibility that the laggard will adopt the new technology and decrease its developmental disadvantage. We also discuss the influence of mobile factors, which reduce regional inequality. The results...

This article is an updated version of the article originally published Online First. The updated version was necessary in order to provide, first, a more detailed illustration of the differences to particularly two other papers of the author (‘Regional inequality.

Background: Since 1 January 2004, all physicians, psychotherapists, and medical care centers that are under contract to statutory healthcare in Germany are obliged, according to &sect, 135a Section 2 of the Fifth Social Security Statute Book, to introduce an intra-institutional quality management system. Methods: A total of 24 medical practices were chosen through random sampling. In total, there were 12 family physicians and specialist practices each and eight practices each per quality management system. The analysis was carried out with the help of three specially developed questionnaires (physician, employee, and patient). A total of 26 quality categories with different questions were available in the three survey groups (physicians, employees, and patients). The Kruskal&ndash, Wallis test checked the extent to which the different scores between the quality management systems were significant and effective for specialists or family physicians. Results: &rdquo, Quality and Development in Practices (QEP)&rdquo, had the highest average score. Due to a specific family practitioner specialism, &ldquo, Quality management in Saxony medical practices (QisA)&rdquo, followed with good average scores. The individual quality categories in the quality management systems, such as the &ldquo, range of services&rdquo, or &ldquo, allocation of appointments&rdquo, received the highest average scores among the specialists. In contrast, categories such as &ldquo, telephone enquiries&rdquo, and &ldquo, external cooperation and communication&rdquo, received the highest average scores among the family physicians. Conclusion: Differences in the evaluation of quality management systems and medical groups (specialists/family physicians) were found in the study. The reasons for these differences could be found in the quality categories.