Social health insurance systems in European countries: the role of the insurer in the health care system: a comparative study of four European countries

This paper examines the role of social health insurance in four European countries: Germany, Switzerland, France and the Netherlands. It attempts to elucidate the organisational structure, regulation and management of the social insurance schemes, as well as the relationships between the insurers, providers and consumers in the various countries with the aim of uncovering some of the inherent strengths, weaknesses and tradeoffs hich exist within social insurance systems.health care systems, Europe, insurance

Public services: are composite measures a robust reflection of performance in the public sector?

A composite indicator is an aggregated index comprising individual performance indicators. Composite indicators integrate a large amount of information in a format that is easily understood and are therefore a valuable tool for conveying a summary assessment of performance in priority areas. This research investigates the degree to which composite measures are an appropriate metric for evaluating performance in the public sector. Do they reflect accurately the performance of organisations? To what degree are they influenced by the uncertainty surrounding underlying indicators on which they are based? Are they robust and stable over time? The construction of composite measures creates specific methodological challenges that make such questions especially pertinent. We address these through a series of quantitative analyses of panel data relating to healthcare (Star ratings of NHS acute Trusts) and local government (Comprehensive Performance Assessment (CPA) ratings of authorities) in England where composites have been widely used. The creation of a composite comprises a number of important steps, each of which requires careful judgement. These include the specification of the choice of indicators, the transformation of measured performance on individual indicators, the specification of a set of weights on individual indicators, and combining the indicators using aggregation methods or decision rules. We use Monte Carlo simulations to examine the robustness of performance judgements to these different technical choices. We show the extent to which composites provide stable performance rankings of organisations over time and assess whether variations are due to genuine performance improvement or merely the result of random statistical variation. The analysis suggests that the judgements that have to be made in the construction of the composite can have a significant impact on the resulting score. Technical and analytical issues in the design of composite indicators have important policy implications. We highlight the issues which need to be considered in the construction of robust composite indicators so that they can be designed in ways which will minimise the potential for producing misleading performance information which may fail to deliver the expected improvements or even induce unwanted side-effects.performance measurement, performance indicators, composite indicators

Trends in health care commissioning in the English NHS: an empirical analysis

In recent years there have been marked changes in organisational structures and budgetary arrangements in the English NHS, potentially altering the relationships between purchasers (primary care organisations (PCOs) and general practices) and providers. Using data on elective hospital admissions from 1997/98 to 2002/03 we find that commissioning has become significantly more concentrated at PCO and GP level. There was a reduction in the average number of different providers used by PCOs (16.7 to 14.2), an increase in the average share of admissions accounted for by the main provider (49% to 69%), and an increase in the average Herfindahl index (0.35 to 0.55). About half the increase in concentration arose from the increase in the number of purchasing organisations from 100 to 302. The rest was due to mergers amongst providers and the abolition of fundholding. GP fundholding practices which held budgets for elective admissions had less concentrated admission patterns than non-fundholders whose admissions were paid for by their primary care organisation. There was an increase in concentration of admissions for both types of GP practice but fundholders used more providers, had smaller shares at their main provider, and had smaller Herfindahl indices.concentration, Herfindahl, purchasing, budgets, elective admissions

Effects of Aquatic Acidification on Calcium Uptake in White River Shrimp Litopenaeus setiferus Gills

Previous research regarding aquatic acidification has examined the protonation of the carbonate and does not consider calcium to be a limiting factor. This is the first study to suggest that pH may affect the uptake of calcium in crustacean gills. This project describes ion transport mechanisms present in the cell membranes of white river shrimp Litopenaeus setiferus gill epithelium, and the effects of pH on the uptake of calcium by these means. Partially purified membrane vesicles (PPMV) of shrimp gills were prepared through a homogenization process that has been used previously to define ion transport in crab and lobster gill tissues. In the current study, shrimp gill PPMV calcium uptake at 50 µM, and 250 µM was greatest at pH 7.0 (p=0.01, p=0.0001). A valinomycin/K+ induced membrane potential (PD) at pH 7.0 significantly increased (p=0.003) calcium uptake from that observed in the absence of a PD. An induced PD at pH 8.0 significantly increased (p=0.003) calcium uptake from that observed in the absence of a PD, however, was not significantly greater than uptake at pH 7.0 in the presence of a PD (p=0.05). Amiloride (2mM) treatments, and amiloride (2mM) + verapamil (100µM) cocktail treatments showed significant decrease in calcium uptake from the control (p=0.03), however, they were not different from each other. This indicates an electrogenic carrier with two driving forces: calcium concentration, and asymmetric exchange stoichiometry

Exploring the impact of public services on quality of life indicators

The fundamental aim of public services is to improve the quality of life of citizens. The main objective of this study was to investigate the influence of public service organisations (PSOs) on aspects of quality of life (broadly measured) of citizens at a local level. We assembled a rich database using 20 of the 45 quality of life measures developed by the Audit Commission. Those we selected covered broad areas of quality of life such as safety, housing, health, education, and transport and were available at ‘small area’ level. We used a range of advanced statistical methods to analyse the relationships between PSOs and quality of life measures at different hierarchical levels. The techniques were selected to be robust when making comparisons between levels and when looking at associations between quality of life measures. Our descriptive analyses (bivariate correlations, factor analysis and ANOVA) suggested overall some significant correlations between some of the quality of life variables. The SUR model results also indicated that the quality of life indicators are correlated, and therefore that we should look at these measures in a joint modelling approach such as MVML, as envisaged in the study objectives.

Zika virus infection in the returning traveller: what every neurologist should know

Zika virus has been associated with a wide range of neurological complications. Neurologists in areas without current active transmission of the virus may be confronted with Zika-associated neurological disease, as a large number of returning travellers with Zika virus infection have been reported and the virus continues to spread to previously unaffected regions. This review provides an overview of Zika virus-associated neurological disease and aims to support neurologists who may encounter patients returning from endemic areas

Information and Communication Technology to Help Students Create Their Own Books the Dialogic Way

The use of Information and Communication Technology (ICT) in language learning allows students to be more engaged and innovative. The present article explores the potential use of technology in the planning, drafting, reviewing, and publishing stages of students’ own book creation. First, the use of digital tools to create books in an interactive and engaging process and format is discussed. Then, the varieties of multimedia books created using ICT are explored. Next, the use of technology for sharing ideas, communicating opinions, collaborating, and reviewing others’ books is explained. The article also describes some collaborative methods students may employ in creating books. Finally, it discusses learners’ development of technology and media literacy in the creation of their own books

On the Relation between the General Affective Meaning and the Basic Sublexical, Lexical, and Inter-lexical Features of Poetic Texts - A Case Study Using 57 Poems of H. M. Enzensberger

The literary genre of poetry is inherently related to the expression and elicitation of emotion via both content and form. To explore the nature of this affective impact at an extremely basic textual level, we collected ratings on eight different general affective meaning scales—valence, arousal, friendliness, sadness, spitefulness, poeticity, onomatopoeia, and liking—for 57 German poems (“die verteidigung der wölfe”) which the contemporary author H. M. Enzensberger had labeled as either “friendly,” “sad,” or “spiteful.” Following Jakobson's (1960) view on the vivid interplay of hierarchical text levels, we used multiple regression analyses to explore the specific influences of affective features from three different text levels (sublexical, lexical, and inter-lexical) on the perceived general affective meaning of the poems using three types of predictors: (1) Lexical predictor variables capturing the mean valence and arousal potential of words; (2) Inter-lexical predictors quantifying peaks, ranges, and dynamic changes within the lexical affective content; (3) Sublexical measures of basic affective tone according to sound-meaning correspondences at the sublexical level (see Aryani et al., 2016). We find the lexical predictors to account for a major amount of up to 50% of the variance in affective ratings. Moreover, inter-lexical and sublexical predictors account for a large portion of additional variance in the perceived general affective meaning. Together, the affective properties of all used textual features account for 43–70% of the variance in the affective ratings and still for 23–48% of the variance in the more abstract aesthetic ratings. In sum, our approach represents a novel method that successfully relates a prominent part of variance in perceived general affective meaning in this corpus of German poems to quantitative estimates of affective properties of textual components at the sublexical, lexical, and inter-lexical level