The Changing Role of the State in the Italian Healthcare System

The present study describes and explains the changing role of the state in the Italian healthcare system since the beginning of the 1970s, with a particular focus on developments following 1978 when the healthcare system was transformed from a social insurance system into a national health service. In order to address these changes in a systematic way, we track healthcare system development along three dimensions: regulation, financing, and service provision. With regard to regulation, we observe a relative retreat of the state due to decentralization processes and internal market mechanisms. Quantitative measures for the financing and service provision dimension also indicate a modest relative retreat of the state. Taking regional data into account, we identify a clear North-South-divide in the public/private mix of financing and service provision. Although the focus of the paper is to describe the changing role of the state in the Italian healthcare system, we also offer preliminary explanations. We seek to identify the role of exogenous shocks such as economic crises versus endogenous stressors specific to the healthcare system itself (i.e. inherent inefficiencies) on healthcare system change. Therefore, the paper aims to provide a tentative, yet dynamic account of healthcare system change that is both descriptive and explanatory.Dieses Papier behandelt die veränderte Rolle des Staates im italienischen Gesundheitssystem seit den 1970er Jahren. Italien vollzog zum Beginn des Untersuchungszeitraums einen Systemwechsel von einem Sozialversicherungssystem zu einem Nationalen Gesundheitsdienst. Um die anschließenden Wandlungsprozesse in systematischer Form zu erfassen, unterscheiden wir zwischen drei Dimensionen von Staatstätigkeit im Gesundheitswesen: Regulierung, Finanzierung und Leistungserbringung. In der Regulierung beobachten wir einen relativen Rückzug des Staates durch Dezentralisierungsprozesse und die partielle Einführung interner Märkte. Dieser Befund deckt sich auch mit den quantitativen Analysen zur Finanzierung und Leistungserbringung. Durch die Einbeziehung regionaler Daten zeigt sich zudem ein klares Nord-Süd-Gefälle, das sich sowohl im öffentlichen Anteil an der Finanzierung als auch an der Leistungserbringung widerspiegelt. Das Papier beschränkt sich nicht auf die Beschreibung des Staatswandels, sondern bietet auch erste Erklärungen für diese Beobachtungen. Dazu werden sowohl exogene Faktoren wie wirtschaftliche Krisen oder Europäisierung als auch endogene Stressoren wie systeminhärente Defizite betrachtet

Evaluation of a robotic technique for transrectal MRI-guided prostate biopsies

Item does not contain fulltextOBJECTIVES: To evaluate the accuracy and speed of a novel robotic technique as an aid to perform magnetic resonance image (MRI)-guided prostate biopsies on patients with cancer suspicious regions. METHODS: A pneumatic controlled MR-compatible manipulator with 5 degrees of freedom was developed in-house to guide biopsies under real-time imaging. From 13 consecutive biopsy procedures, the targeting error, biopsy error and target displacement were calculated to evaluate the accuracy. The time was recorded to evaluate manipulation and procedure time. RESULTS: The robotic and manual techniques demonstrated comparable results regarding mean targeting error (5.7 vs 5.8 mm, respectively) and mean target displacement (6.6 vs 6.0 mm, respectively). The mean biopsy error was larger (6.5 vs 4.4 mm) when using the robotic technique, although not significant. Mean procedure and manipulation time were 76 min and 6 min, respectively using the robotic technique and 61 and 8 min with the manual technique. CONCLUSIONS: Although comparable results regarding accuracy and speed were found, the extended technical effort of the robotic technique make the manual technique - currently - more suitable to perform MRI-guided biopsies. Furthermore, this study provided a better insight in displacement of the target during in vivo biopsy procedures.01 februari 201

Growing old at home – A randomized controlled trial to investigate the effectiveness and cost-effectiveness of preventive home visits to reduce nursing home admissions: study protocol [NCT00644826]

<p>Abstract</p> <p>Background</p> <p>Regarding demographic changes in Germany it can be assumed that the number of elderly and the resulting need for long term care is increasing in the near future. It is not only an individual's interest but also of public concern to avoid a nursing home admission. Current evidence indicates that preventive home visits can be an effective way to reduce the admission rate in this way making it possible for elderly people to stay longer at home than without home visits. As the effectiveness and cost-effectiveness of preventive home visits strongly depends on existing services in the social and health system existing international results cannot be merely transferred to Germany. Therefore it is necessary to investigate the effectiveness and cost-effectiveness of such an intervention in Germany by a randomized controlled trial.</p> <p>Methods</p> <p>The trial is designed as a prospective multi-center randomized controlled trial in the cities of Halle and Leipzig. The trial includes an intervention and a control group. The control group receives usual care. The intervention group receives three additional home visits by non-physician health professionals (1) geriatric assessment, (2) consultation, (3) booster session.</p> <p>The nursing home admission rate after 18 months will be defined as the primary outcome. An absolute risk reduction from a 20% in the control-group to a 7% admission rate in the intervention group including an assumed drop out rate of 30% resulted in a required sample size of N = 320 (n = 160 vs. n = 160).</p> <p>Parallel to the clinical outcome measurement the intervention will be evaluated economically. The economic evaluation will be performed from a society perspective.</p> <p>Discussion</p> <p>To the authors' knowledge for the first time a trial will investigate the effectiveness and cost-effectiveness of preventive home visits for people aged 80 and over in Germany using the design of a randomized controlled trial. Thus, the trial will contribute to the existing evidence on preventive home visits especially in Germany.</p

The influence of age, gender and socio-economic status on multimorbidity patterns in primary care. first results from the multicare cohort study

Background: Multimorbidity is a phenomenon with high burden and high prevalence in the elderly. Our previous research has shown that multimorbidity can be divided into the multimorbidity patterns of 1) anxiety, depression, somatoform disorders (ADS) and pain, and 2) cardiovascular and metabolic disorders. However, it is not yet known, how these patterns are influenced by patient characteristics. The objective of this paper is to analyze the association of socio-demographic variables, and especially socio-economic status with multimorbidity in general and with each multimorbidity pattern. Methods: The MultiCare Cohort Study is a multicentre, prospective, observational cohort study of 3.189 multimorbid patients aged 65+ randomly selected from 158 GP practices. Data were collected in GP interviews and comprehensive patient interviews. Missing values have been imputed by hot deck imputation based on Gower distance in morbidity and other variables. The association of patient characteristics with the number of chronic conditions is analysed by multilevel mixed-effects linear regression analyses. Results: Multimorbidity in general is associated with age (+0.07 chronic conditions per year), gender (-0.27 conditions for female), education (-0.26 conditions for medium and -0.29 conditions for high level vs. low level) and income (-0.27 conditions per logarithmic unit). The pattern of cardiovascular and metabolic disorders shows comparable associations with a higher coefficient for gender (-1.29 conditions for female), while multimorbidity within the pattern of ADS and pain correlates with gender (+0.79 conditions for female), but not with age or socioeconomic status. Conclusions: Our study confirms that the morbidity load of multimorbid patients is associated with age, gender and the socioeconomic status of the patients, but there were no effects of living arrangements and marital status. We could also show that the influence of patient characteristics is dependent on the multimorbidity pattern concerned, i.e. there seem to be at least two types of elderly multimorbid patients. First, there are patients with mainly cardiovascular and metabolic disorders, who are more often male, have an older age and a lower socio-economic status. Second, there are patients mainly with ADS and pain-related morbidity, who are more often female and equally distributed across age and socio-economic groups

Informal Home Care and Labor Force Participation of Household Members

In Germany, informal home care is preferred to professional care services in the public discussion as well as in legal care regulations. However, they ascribe only minor importance to the opportunity costs care givers have to face. Therefore, this paper explores the influence home care has on the labor supply of carers who live together with their care recipient. I am using the German Socio-Economic Panel of the years 2001 to 2007 which allows the characteristics of both groups to be merged. Furthermore, I look at female and male care givers separately. The results show that having an individual in need of care in the household does not decrease labor supply to an economically relevant extent. As caring and the labor supply decision might be endogenous, I test for endogeneity by using characteristics of care recipients as instruments and I look at sample attrition. In addition, the panel structure allows to control for unobserved heterogeneity, which is probably strong for care

Competing for Public Resources: Higher Education and Academic Research in Europe. A Cross-Sectoral Perspective

The chapter focuses on the increasing cross-sectoral competition for public resources between various types of public sector institutions in Europe and its implications for future public funding for both higher education and academic research. It views the major models of the institution of the modern (Continental) university and the major types of the modern institution of the state, and of the welfare state in particular, as traditionally closely linked (following Kogan et al., 2000; Kogan and Hanney, 2000; Becher and Kogan, 1992). Historically, in the post-war period in Europe, the unprecedented growth of welfare states and state-funded public services was paralleled by the unprecedented growth of public universities. The massification and universalization of higher education in Europe coincided with the growth of the welfare state in general. Currently, both processes in higher education are in full swing across Europe while welfare states are under the most far-reaching restructuring in their postwar history. The major implication is the fierce competition for public resources, studied in this chapter from a cross-sectoral perspective, in which the future levels of public funding for higher education in tax-based European systems are highly dependent on social attitudes towards what higher education brings to society and the economy, relative to what other claimants to the public purse can bring to them

International Labor Migration, Economic Growth and Labor Markets - The Current State of Affairs

Even though European labor markets are characterized by high average unemployment, there is a shortage of high-skilled labor, leading many European economists to argue for an immigration policy directed at actively recruiting highly qualified workers from abroad. It has further been argued that an immigration policy that is tailored to attract young and economically successful migrants can alleviate some of the demographic burden associated with an aging population.We embed this discussion into a systematic classification of economic migration research according to its major conceptual and applied questions. The state of theoretical and empirical research on the migration decision, the literature on the economic performance of immigrants and their economic impact is reviewed briefly, proceeding along the lines of a clear conceptual framework. In addition, the paper discusses expectations on future migration flows and the policy options of immigration countries for dealing with these flows