Datenlage im deutschen Gesundheits- und Sozialwesen

The german data on health care and social policy are very heterogeneous. Moreover they are compiled and made accessible by a large number of different institutions. The objective of the report is, as a service for students and researchers less familiar with data sources, to provide a comprehensive overview over available data in these subject areas. For this purpose a general introductory section deals with requirements of data, deficits of the existing data sources as well as recommendations for improving the situation. In a second special section information on individual statistics are presented in the form of systematic synopses. Statistics include information on the insured persons in social insurances, beneficiaries, providers of services, expenditures and revenues for benefits. The latter includes the statistics on economic aggregates as well as the distribution over socio-economic groups. Due to the extensive number of sources the presentation is confined to data compiled by public institutions (public households, ministries, social security institutions and the federal bureau of statistics) as well as two examples of a successful integration of survey data with administrative data.public health, social policy, public finance

Kopfpauschalen zur Finanzierung der Krankenversicherungsleistungen in Deutschland

Recently several experts have proposed to replace the existing social health insurance revenue system by income-independent per capita contributions. Therefore the authors of this paper present different estimates for alternative forms of per capita contributions. The next step of the analysis involves calculating the reduction or increase in contribution burden following a change to a per capita contribution system. Furthermore the volume of the tax transfer required to off-set the lower income groups’ massive worsening of their income position and the higher income groups’ increased tax burden is estimated. Some of the problems involved in the practical application of introducing such a revenue system in Switzerland – the only European country applying this form of financing alternative – are addressed. The concluding section summarizes the effects of such a revenue system.Social Health Insurance System, Public Finance

Buergerversicherung vs. Gesundheitspraemie – Vergleich der Reformoptionen zur Finanzierung der Gesetzlichen Krankenversicherung

The wage-dependence of the Public Health Insurance (PHI) as well as the somewhat inconsistent parallel coverage via PHI and private health insurance constitute drawbacks of the present health care revenue system, leading to undesirable distributional and allocative patterns and disadvantages in the course of demographic and economic change. Two conflicting approaches, the “Buergerversicherung” (“Citizens’ Health Insurance”) and the “Gesundheitsprämie” (“Flat Rate Health Insurance”) try to remedy these by way of different methods – the former with a statutory health insurance for all and a comprehensive income basis for proportionate health insurance contributions, the latter with a flat rate contribution for the present PHI including a massive tax subsidy for the contributions for low-income groups and children. The paper presents simulations of the distributional effects. Differing effects become evident. Moreover these patterns also reflect different “philosophies” of social welfare and public revenue regimes. The “Bürgerversicherung” reduces payments by wage and wage-replacement earners and generally by low income groups, the “Gesundheitspraemie” favors higher-income individuals and particularly two-earner married couples.Social Health Insurance System, Public Finance

Zuzahlungen nach dem GKV-Modernisierungsgesetz (GMG) unter Beruecksichtigung von Haertefallregelungen

The law for the Modernisation of the Social Health Insurance System 2003 ("GKV-Modernisierungsgesetz – GMG" 2003) provides, among other measures, for a noticeable increase in co-payments and also for a reduction of possibilities for claiming exemptions from co-payments. Against this backdrop, the authors of the paper present, at the start, the varying news on co-insurance payments held by different political groups. Thereafter, the theoretical foundations of co-payments are described. Finally, on the basis of extensive empirically founded computations, the effects of the new co-payment rules (together with relevant new exemptions) are compared with the effects of the rules still in force.Social Health Insurance System, co-payment, public finance

Steuerung des GKV-Arzneimittelmarktes – Auswirkungen von Selbstbeteiligungen und Härtefallregelungen

This analysis shows that hardship and not hardship cases respectively reject clear differences both at the demand and at the expenditures for pharmaceuticals financed by the statutory health insurance. Hardship cases without exemption regulations would be burden therefore by enormous co-payments. Moreover, it also turns out that straight hardship cases are less healthy on average than not hardship cases. Co-payments without accompanying hardship case regulations would therefore hardly make a supply possible adapted to the needs of hardship cases. On the other hand the effectivity of drug co-payment regulations is reduced by hardship case regulations considerably.co-payments, pharmaceutical market, statutory health insurance, public finance

Datenlage im deutschen Gesundheits- und Sozialwesen

Die Daten des deutschen Gesundheits- und Sozialwesens sind sehr heterogen und zudem bei den unterschiedlichsten Institutionen erfasst und zugänglich. Ziel des vorliegenden Berichts ist es, als "Dienstleistung" für Studierende und Forschende, die weniger vertraut mit Datenquellen sind, die aktuelle Datenlage im Gesundheits- und Sozialwesen umfassend darzustellen. Dazu werden in einem allgemeinen Teil Anforderungen an die Aussagefähigkeit von Daten im Gesundheits- und Sozialwesen formuliert, Defizite herausgestellt sowie Empfehlungen für eine Verbesserung der Datenlage gegeben. In einem speziellen Teil werden im Anschluss an die allgemeinen Ausführungen die einzelnen Statistikbereiche in synoptischer Form dargestellt. Es wird sowohl auf Statistiken über Versicherte, Leistungsbezieher, Leistungserbringer, Ausgaben für Leistungen und ihre Finanzierung, Ausgaben- und Einnahmenaggregate wie auch über die Verteilung auf Empfängergruppen eingegangen. Aufgrund der enormen Heterogenität der Institutionen, Maßnahmen und Daten im Gesundheits- und Sozialwesen bezieht sich die Darstellung nur auf amtliche Daten sowie auf zwei Beispiele einer gelungenen Verzahnung zwischen Prozess- und Befragungsdaten.The german data on health care and social policy are very heterogeneous. Moreover they are compiled and made accessible by a large number of different institutions. The objective of the report is, as a service for students and researchers less familiar with data sources, to provide a comprehensive overview over available data in these subject areas. For this purpose a general introductory section deals with requirements of data, deficits of the existing data sources as well as recommendations for improving the situation. In a second special section information on individual statistics are presented in the form of systematic synopses. Statistics include information on the insured persons in social insurances, beneficiaries, providers of services, expenditures and revenues for benefits. The latter includes the statistics on economic aggregates as well as the distribution over socio-economic groups. Due to the extensive number of sources the presentation is confined to data compiled by public institutions (public households, ministries, social security institutions and the federal bureau of statistics) as well as two examples of a successful integration of survey data with administrative data

Plasma-neutral interactions in the lower thermosphere-ionosphere : The need for in situ measurements to address focused questions

The lower thermosphere-ionosphere (LTI) is a key transition region between Earth's atmosphere and space. Interactions between ions and neutrals maximize within the LTI and in particular at altitudes from 100 to 200 km, which is the least visited region of the near-Earth environment. The lack of in situ co-temporal and co-spatial measurements of all relevant parameters and their elusiveness to most remote-sensing methods means that the complex interactions between its neutral and charged constituents remain poorly characterized to this date. This lack of measurements, together with the ambiguity in the quantification of key processes in the 100-200 km altitude range affect current modeling efforts to expand atmospheric models upward to include the LTI and limit current space weather prediction capabilities. We present focused questions in the LTI that are related to the complex interactions between its neutral and charged constituents. These questions concern core physical processes that govern the energetics, dynamics, and chemistry of the LTI and need to be addressed as fundamental and long-standing questions in this critically unexplored boundary region. We also outline the range of in situ measurements that are needed to unambiguously quantify key LTI processes within this region, and present elements of an in situ concept based on past proposed mission concepts.Peer reviewe

Lower-thermosphere–ionosphere (LTI) quantities: current status of measuring techniques and models

The lower-thermosphere-ionosphere (LTI) system consists of the upper atmosphere and the lower part of the ionosphere and as such comprises a complex system coupled to both the atmosphere below and space above. The atmospheric part of the LTI is dominated by laws of continuum fluid dynamics and chemistry, while the ionosphere is a plasma system controlled by electromagnetic forces driven by the magnetosphere, the solar wind, as well as the wind dynamo. The LTI is hence a domain controlled by many different physical processes. However, systematic in situ measurements within this region are severely lacking, although the LTI is located only 80 to 200 km above the surface of our planet. This paper reviews the current state of the art in measuring the LTI, either in situ or by several different remote-sensing methods. We begin by outlining the open questions within the LTI requiring high-quality in situ measurements, before reviewing directly observable parameters and their most important derivatives. The motivation for this review has arisen from the recent retention of the Daedalus mission as one among three competing mission candidates within the European Space Agency (ESA) Earth Explorer 10 Programme. However, this paper intends to cover the LTI parameters such that it can be used as a background scientific reference for any mission targeting in situ observations of the LTI.Peer reviewe

The National COVID Cohort Collaborative (N3C): Rationale, design, infrastructure, and deployment.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) poses societal challenges that require expeditious data and knowledge sharing. Though organizational clinical data are abundant, these are largely inaccessible to outside researchers. Statistical, machine learning, and causal analyses are most successful with large-scale data beyond what is available in any given organization. Here, we introduce the National COVID Cohort Collaborative (N3C), an open science community focused on analyzing patient-level data from many centers. MATERIALS AND METHODS: The Clinical and Translational Science Award Program and scientific community created N3C to overcome technical, regulatory, policy, and governance barriers to sharing and harmonizing individual-level clinical data. We developed solutions to extract, aggregate, and harmonize data across organizations and data models, and created a secure data enclave to enable efficient, transparent, and reproducible collaborative analytics. RESULTS: Organized in inclusive workstreams, we created legal agreements and governance for organizations and researchers; data extraction scripts to identify and ingest positive, negative, and possible COVID-19 cases; a data quality assurance and harmonization pipeline to create a single harmonized dataset; population of the secure data enclave with data, machine learning, and statistical analytics tools; dissemination mechanisms; and a synthetic data pilot to democratize data access. CONCLUSIONS: The N3C has demonstrated that a multisite collaborative learning health network can overcome barriers to rapidly build a scalable infrastructure incorporating multiorganizational clinical data for COVID-19 analytics. We expect this effort to save lives by enabling rapid collaboration among clinicians, researchers, and data scientists to identify treatments and specialized care and thereby reduce the immediate and long-term impacts of COVID-19