The changing public/private mix in the American Health Care System

This paper discusses the fundamental changes in the American health care system during the past four decades. By applying a multidimensional framework, the changing role of the state in financing, service provision, and in the regulation of the health care system are scrutinized. The results suggest a considerable blurring of the private, market based health care system of the United States. While the state constantly retreats from service provision, it substantially intensifies its engagement in financing and also in the regulation of the system. The most path-breaking changes in regulation, however, are observed through the introduction of managed care, which, from a private market side, brought new elements of hierarchical coordination into the system. --

TES: A modular systems approach to expert system development for real-time space applications

A major goal of the Space Station era is to reduce reliance on support from ground based experts. The development of software programs using expert systems technology is one means of reaching this goal without requiring crew members to become intimately familiar with the many complex spacecraft subsystems. Development of an expert systems program requires a validation of the software with actual flight hardware. By combining accurate hardware and software modelling techniques with a modular systems approach to expert systems development, the validation of these software programs can be successfully completed with minimum risk and effort. The TIMES Expert System (TES) is an application that monitors and evaluates real time data to perform fault detection and fault isolation tasks as they would otherwise be carried out by a knowledgeable designer. The development process and primary features of TES, a modular systems approach, and the lessons learned are discussed

Fair financing in Germany's public health insurance: income-related contributions or flat premiums

Social justice in health care insurance relates to both, the utilisation of services and the financing of the system. With respect to the latter, in its World Health Report 2000 the WHO promoted a concept of fair financing that asks for contributions to health care financing that are proportional to households' capacity to pay. This claim contains three dimensions: the rejection of risk-related premiums, the claim that all households with equal income should pay equal premiums (horizontal justice), and the suggestion that higher income should lead to proportionally higher premiums (vertical justice). In this paper we first discuss the normative dimension of fair financing and develop a slightly modified version of the WHO's normative framework. Second, empirical findings based on WHO data and on data from the ECuity project are presented for selected countries. While the WHO concept does not allow drawing unambiguous conclusions, the latter shows, that Germany's system is regressive. With respect to the normative framework developed we can therefore conclude that future reforms should make the system more progressive. Against this background, two recent alternative strategies for reforming health financing, the Bürgerversicherung and the Gesundheitsprämie, are discussed. While both reform options are to be judged as more or less equivalent regarding horizontal justice and the rejection of risk-related premiums, some evidence is given towards the inferiority of the Gesundheitsprämie model with respect to vertical justice. --

Can local single-pass methods solve any stationary Hamilton-Jacobi-Bellman equation?

The use of local single-pass methods (like, e.g., the Fast Marching method) has become popular in the solution of some Hamilton-Jacobi equations. The prototype of these equations is the eikonal equation, for which the methods can be applied saving CPU time and possibly memory allocation. Then, some natural questions arise: can local single-pass methods solve any Hamilton-Jacobi equation? If not, where the limit should be set? This paper tries to answer these questions. In order to give a complete picture, we present an overview of some fast methods available in literature and we briefly analyze their main features. We also introduce some numerical tools and provide several numerical tests which are intended to exhibit the limitations of the methods. We show that the construction of a local single-pass method for general Hamilton-Jacobi equations is very hard, if not impossible. Nevertheless, some special classes of problems can be actually solved, making local single-pass methods very useful from the practical point of view.Comment: 19 page

Blended numerical schemes for the advection equation and conservation laws

In this paper we propose a method to couple two or more explicit numerical schemes approximating the same time-dependent PDE, aiming at creating new schemes which inherit advantages of the original ones. We consider both advection equations and nonlinear conservation laws. By coupling a macroscopic (Eulerian) scheme with a microscopic (Lagrangian) scheme, we get a new kind of multiscale numerical method

Role of acetaldehyde in alcohol addiction : current evidence and future perspectives

The effects of alcohol have been widely studied during the past century, corroborating the idea that this tiny chemical compound acts throughout most of our neurotransmitter systems since it is capable of inducing addictive behaviour. Two of the most serious problems of alcohol addiction are craving and relapse; several studies have demonstrated that relapse is related to the anxious state which occurs during withdrawal, and it has been proved that this behavioural modifications results from an alteration of the dopaminergic and serotonergic systems. An important role in the neurobiology of alcohol addiction is played by acetaldehyde (ACD), ethanol first metabolite. Our recent studies indeed, have demonstrated that ACD itself is able to induce CRH release from hypothalamic explants, underlying the central role played by ACD in alcohol-induced modifications of the HPA axis. Moreover, for the first time, this group has shown that ACD is able to induce and maintain an operant drinking behaviour after repeated abstinence periods, and in the presence of a conflict situation in rats, mimicking the same characteristics as alcohol. ACD is produced either peripherally or within the brain by alcohol dehydrogenase and catalase, respectively. Studies assert that the highest concentrations of catalase in the brain are mainly located in aminergic neurons suggesting that ACD could take part in alcohol action in those circuitries. Further investigations are then necessary to fully understand the molecular mechanisms underlying the neurochemical and behavioural modifications induced by ACD, as a mediator of alcohol activity in the brain.peer-reviewe

A differential model for growing sandpiles on networks

We consider a system of differential equations of Monge-Kantorovich type which describes the equilibrium configurations of granular material poured by a constant source on a network. Relying on the definition of viscosity solution for Hamilton-Jacobi equations on networks, recently introduced by P.-L. Lions and P. E. Souganidis, we prove existence and uniqueness of the solution of the system and we discuss its numerical approximation. Some numerical experiments are carried out

A numerical method for Mean Field Games on networks

We propose a numerical method for stationary Mean Field Games defined on a network. In this framework a correct approximation of the transition conditions at the vertices plays a crucial role. We prove existence, uniqueness and convergence of the scheme and we also propose a least squares method for the solution of the discrete system. Numerical experiments are carried out