The introduction of deductibles for prescription drugs in a national health insurance: Compulsory or voluntary?

We consider a situation of full insurance coverage for prescription drugs where, at a certain point in time, people are given the opportunity to take a deductible in exchange for a lower premium. Four determinants of this premium reduction can be considered: expected out-of-pocket payments, adverse selection effects, moral hazard effects, and administration costs. The purpose of this study is to analyse the first two determinants. Survey data of 17 242 insureds in the Netherlands have been used for this research. Results show that the expected out-of-pocket expenditures in case of a certain deductible amount depend strongly on age and gender. People in poor health could be given a larger premium discount if they would take a deductible than those in good health. This implies that a uniform premium discount would induce adverse selection. The effects of such selection have been simulated by using a survey question about the preference to take a general deductible. If the premium reductions for policies with a deductible are adjusted for age and gender, the selection effect will halve but will still be substantial. We conclude that, in the situation considered here, it is largely immaterial whether deductibles are compulsory or voluntary, provided premium reductions are allowed to depend on relevant risk factors

Effecten van eigen betalingen op premies voor ziektekostenverzekeringen

De premie voor een verzekering met een eigen risico is lager dan die voor een verzekering zonder een eigen risico. In dit onderzoek staat deze premiekorting bij ziektekostenverzekeringen centraal. Hoe hoog kan de premiekorting vanwege een vorm van eigen betaling zijn? Zorgbehoeftigen, die bij een eigen risico relatief veel zelf zullen gaan betalen, zouden een hogere premiekorting kunnen krijgen dan gezonde mensen. Bovendien zouden verzekerden met een premiekorting kunnen worden beloond als zij door het eigen risico minder gebruik van medische zorg gaan maken. In geval van een vrijwillig eigen risico met een uniforme premiekorting zullen in het algemeen gezonde mensen kiezen voor een eigen risico en zullen zorgbehoeftigen veelal de voorkeur geven aan een volledige verzekering. Hierdoor kunnen verzekerden die kiezen voor een eigen risico een premiekorting krijgen. Voordat verder wordt ingegaan op de vraag naar de hoogte van de premiekorting, znllen enkele begrippen worden omschreven en uitgelegd

Linking models for land use analysis: experiences from the SENSOR project

In order to quantify the effects of a comprehensive set of policies on land use, interaction between sectors needs to be accounted for, while maintaining a high level of detail for each sector. This calls for a combination of sector specific and sector wide models. This paper describes such a modelling system, with emphasis on the linking of the models to a coherent system. Five sectors of significant importance for land use are modelled individually: Forestry, agriculture, urban land use, transport infrastructure, and tourism. All models are connected as sub-modules to an economy-wide partial econometric model. In addition, a land cover model is used to disaggregate land use down to 1km grid resolution. The linking of such a diverse set of models in a consistent way poses conceptual as well as practical issues. The conceptual issues concern questions such as which items of the models to link, how to obtain a stable joint baseline scenario, and how to obtain a joint equilibrium solution for all models simultaneously in simulation. Practical issues concern the actual implementation of the conceptually sound linkages and provision of a workable technical solution. The linked system allows us to introduce a shock in either of the models, and the set of results will provide a joint solution for all sectors modelled in SENSOR. In this manner, the models take a complex policy scenario as argument and compute a comprehensive set of variables involving all five land use sectors on regional level, which in turn forms a basis for distilling out the impact on sustainability in the form of indicators. Without the extensive automation and technical linkages, it would not have been possible to obtain a joint equilibrium, or it would have required exorbitant amounts of working time.Model linking, sustainable land use, cross sector modelling, iterative recalibration, Land Economics/Use,

Reconciliation of inconsistent data sources using hidden Markov models

This paper discusses how National Statistical Institutes (NSI's) can use hidden Markov models (HMMs) to produce consistent official statistics for categorical, longitudinal variables using inconsistent sources. Two main challenges are addressed: first, the reconciliation of inconsistent sources with multi-indicator HMMs requires linking the sources on the micro level. Such linkage might lead to bias due to linkage error. Second, applying and estimating HMMs regularly is a complicated and expensive procedure. Therefore, it is preferable to use the error parameter estimates as a correction factor for a number of years. However, this might lead to biased structural estimates if measurement error changes over time or if the data collection process changes. Our results on these issues are highly encouraging and imply that the suggested method is appropriate for NSI's. Specifically, linkage error only leads to (substantial) bias in very extreme scenarios. Moreover, measurement error parameters are largely stable over time if no major changes in the data collection process occur. However, when a substantial change in the data collection process occurs, such as a switch from dependent (DI) to independent (INDI) interviewing, re-using measurement error estimates is not advisable

A selection of sensing techniques for mapping soil hydraulic properties

Data on soil hydraulic properties are needed as input for many models, such as models to predict unsaturated water movement and crop growth, and models to predict leaching of nutrients and pesticides to groundwater. The soil physics database of the Netherlands shows several lacunae, and a substantial part of the data were collected more than thirty years ago and thus might not represent actual soil hydraulic conditions

Lage ciclosporinespiegel na kort rifampicinegebruik : immuunsuppressie kan langdurig tekortschieten

Cyclosporin is an immunosuppressive agent with a wide range of therapeutic uses. In transplant patients, it is used for the prevention of rejection and graft-versus-host reactions. The metabolism and bioavailability of cyclosporin can be significantly and persistently influenced through induction of CYP3A4 caused by the concomitant use of rifampicin. However, awareness of the need for the timely and frequent monitoring of cyclosporin levels during and especially after treatment with rifampicin has not fully been addressed. Here, we describe 3 patient cases concerning significant episodes of sub-therapeutic cyclosporin levels after short-term rifampicin therapy. Rifampicin was administered for three to five days and decreased cyclosporin levels were observed ± 7 days after the initiation of rifampicin, and continued during the following weeks even after the cessation of rifampicin therapy. Cyclosporin dosage-adjustments were made based on the cyclosporin blood levels and all 3 patients showed good therapeutic and clinical responses.Zelfs kortdurend gebruik van het antibioticum rifampicine kan de ciclosporineconcentratie in het bloed verlagen. Daarom moet de bloedspiegel van dit immunosuppressivum goed gemonitord worden bij patiënten die ook rifampicine krijgen, ook als de patiënt al gestopt is met het middel. Om afstoting van transplantaten of graft-versus-hostreacties te voorkómen, is het vaak nodig de ciclosporinedosering aan te passen

Projecting the Bethe-Salpeter Equation onto the Light-Front and back: A Short Review

The technique of projecting the four-dimensional two-body Bethe-Salpeter equation onto the three-dimensional Light-Front hypersurface, combined with the quasi-potential approach, is briefly illustrated, by placing a particular emphasis on the relation between the projection method and the effective dynamics of the valence component of the Light-Front wave function. Some details on how to construct the Fock expansion of both i) the Light-Front effective interaction and ii) the electromagnetic current operator, satisfying the proper Ward-Takahashi identity, will be presented, addressing the relevance of the Fock content in the operators living onto the Light-Front hypersurface. Finally, the generalization of the formalism to the three-particle case will be outlined.Comment: 16 pages, macros included. Mini-review to be printed in a regular issue of Few-Body Systems devoted to the Workshop on "Relativistic Description of Two- and Three-body Systems in Nuclear Physics" ECT* Trento, 19 - 23 October 200

Dupilumab shows long-term effectiveness in a large cohort of treatment-refractory atopic dermatitis patients in daily practice:52-Week results from the Dutch BioDay registry

Background Real-life data on long-term effectiveness and safety of dupilumab in atopic dermatitis patients are limited. Objective To study 52-week effectiveness and safety of dupilumab in a prospective multicenter cohort of adult patients with treatment-refractory atopic dermatitis. Methods Patients treated with dupilumab and participating in the Dutch BioDay registry were included. Clinical effectiveness and safety were evaluated. Results Two hundred ten atopic dermatitis patients were included. Mean percentage change in Eczema Area and Severity Index score after 16 weeks was –70.0% (standard deviation 33.2%) and further decreased to –76.6% (standard deviation 30.6%) by week 52. A greater than or equal to 75% improvement in the score was achieved by 59.9% of individuals by week 16 and by 70.3% by week 52. The most reported adverse effect was conjunctivitis (34%). Limited patients (17; 8.1%) discontinued dupilumab treatment. Limitations Because of the lack of a control group and observational design, factors of bias may have been induced. Conclusion Treatment with dupilumab resulted in a rapid improvement in clinical outcome measures, and effectiveness further improved during the 52-week follow-up period

Electromagnetic and weak current operators for interacting systems within the front-form dynamics

Electromagnetic and weak current operators for interacting systems should properly commute with the Poincar\'e generators and satisfy Hermiticity. The electromagnetic current should also satisfy ${\cal P}$ and ${\cal T}$ covariance and continuity equation. We show that in front-form dynamics the current can be constructed from auxiliary operators, defined in a Breit frame where initial and final three-momenta of the system are directed along the $z$ axis. Poincar\'e covariance constraints reduce for auxiliary operators to the ones imposed only by kinematical rotations around the $z$ axis; while Hermiticity requires a suitable behaviour of the auxiliary operators under rotations by $\pi$ around the $x$ or $y$ axes. Applications to deep inelastic structure functions and electromagnetic form factors are discussed. Elastic and transition form factors can be extracted without any ambiguity and in the elastic case the continuity equation is automatically satisfied, once Poincar\'e, ${\cal P}$ and ${\cal T}$ covariance, together with Hermiticity, are imposed.Comment: 40 pages, submitted to Nucl. Phys.