Keeping an Eye on Iris: Risk and Income Solidarity in OECD Healthcare Systems

In most wealthy democracies as represented by long-term OECD-members, healthcare systems have been established which guarantee access to a broad package of health services. However, healthcare financing involves varying distributive effects and builds on different concepts of solidarity. Healthcare researchers have examined these equity issues in healthcare financing measuring the progressivity of healthcare financing using micro-level data. Most notably, the ECuity-project published progressivity indices in some European countries and the US for the late 1980s and early 1990s. Not least due to the rather complex procedure involved with the evaluation of income and expenditure surveys, such indices have been rarely calculated since. From these studies on redistributive effects, we know that the main modes of financing quite consistently correspond to different levels of progressivity. Moreover, financing modes reflect different concepts of solidarity. Therefore, we suggest an alternative indicator to explore equity issues in healthcare financing using aggregate spending and revenue data. The Index of Risk and Income Solidarity (IRIS) is based on the respective share of distinct modes of financing. We distinguish modes of financing which involve ex-ante redistribution of health risks from those which entail only ex-post redistribution or none at all. Further, we differentiate financing modes which are related to personal or household income from those which involve no income redistribution. We assume an increase of risk solidarity as well as a decline of income solidarity in the OECD-world. First of all, new and costly medical technologies drive the demand for ex-ante redistribution of health risks. At the same time, hopes to increase efficiency of healthcare provision through forms of co-payments have been disappointed. The decline of income solidarity is expected as a result of global competition. In order to reduce labour costs, OECD countries substitute social security contributions by flat-rate premiums or general taxes. In the light of global competition, governments also tend to strengthen indirect taxes since it is far more difficult to shift consumption abroad. Finally, we assume that it is easier to legitimize rising tobacco or alcohol taxes if they are ear-marked for healthcare financing. We examine these assumptions presenting time series of risk and income solidarity based on OECD health data, OECD revenue statistics and national aggregate data on healthcare financing. We cover eleven OECD countries: Australia, Belgium, Canada, Denmark, France, Germany, Japan, the Netherlands, Switzerland, the UK and the US. These countries reflect a broad spectrum of healthcare system types in the OECD-world. The observation period starts at the eve of the first oil crisis in the 1970s and ends at the onset of the Great Recession in 2009.In den meisten OECD-Ländern haben sich Gesundheitssysteme etabliert, die den allgemeinen Zugang zu umfassender medizinischer Versorgung sicherstellen. Die Finanzierung dieser Gesundheitssysteme hat unterschiedliche distributive Effekte zur Folge. Damit verbundene Gerechtigkeitsfragen wurden über die Messung des Progressivitätsgrades der Finanzierungs-instrumente erforscht. Insbesondere das ECuity-Project hat Progressivitätsindizes von einigen europäischen Staaten und den USA für die späten 1980er und die frühen 1990er Jahre veröffentlicht. Aufgrund der aufwändigen Berechnungsweise mit verschiedenen Individualdatensätzen wurden solche Indizes seither selten veröffentlicht. Auf Grundlage dieser Studien ist dokumentiert, dass die Finanzierungsquellen der Gesundheitssysteme mit unterschiedlichen redistributiven Effekten verbunden sind. Wir nutzen diese Informationen, um aus Aggregatdaten einen Indikator zu bilden, der Umverteilungswirkungen in der Finanzierungsdimension des Gesundheitssystems abbildet. Dabei unterscheiden wir auf der einen Seite Finanzierungsformen, die eine Umverteilung des Krankheitsrisikos bedeuten und auf der anderen Seite Finanzierungsformen, die eine Einkommensumverteilung einschließen, indem sie höhere Einkommen zumindest proportional stärker belasten. Aus dem Anteil der so charakterisierten Finanzierungsformen entwickeln wir einen Index der Risiko- und Einkommenssolidarität (IRIS). Ausgehend von einer starken Nachfrage nach Risikoumverteilung, um den Zugang zum Gesundheitssystem bei steigenden Kosten und Bedarfen zu gewährleisten, vermuten wir einen langfristigen Anstieg der Risikosolidarität. Dahingegen könnte die Einkommenssolidarität aufgrund von internationalem Wettbewerb um Investitionskapital schwächer werden. Diese Annahmen werden für 11 OECD-Länder (Australien, Belgien, Dänemark, Deutschland, Frankreich, Japan, die Niederlande, Kanada, die Schweiz, das UK und die USA) und einen Beobachtungszeitraum von 1970 bis 2009 untersucht

Measurement of charged particle spectra in minimum-bias events from proton-proton collisions at root s =13 TeV

Pseudorapidity, transverse momentum, and multiplicity distributions are measured in the pseudorapidity range vertical bar eta vertical bar 0.5 GeV in proton-proton collisions at a center-of-mass energy of root s = 13 TeV. Measurements are presented in three different event categories. The most inclusive of the categories corresponds to an inelastic pp data set, while the other two categories are exclusive subsets of the inelastic sample that are either enhanced or depleted in single diffractive dissociation events. The measurements are compared to predictions from Monte Carlo event generators used to describe high-energy hadronic interactions in collider and cosmic-ray physics.Peer reviewe

Patterns of oral anticoagulant use and outcomes in Asian patients with atrial fibrillation: a post-hoc analysis from the GLORIA-AF Registry

Background: Previous studies suggested potential ethnic differences in the management and outcomes of atrial fibrillation (AF). We aim to analyse oral anticoagulant (OAC) prescription, discontinuation, and risk of adverse outcomes in Asian patients with AF, using data from a global prospective cohort study. Methods: From the GLORIA-AF Registry Phase II-III (November 2011-December 2014 for Phase II, and January 2014-December 2016 for Phase III), we analysed patients according to their self-reported ethnicity (Asian vs. non-Asian), as well as according to Asian subgroups (Chinese, Japanese, Korean and other Asian). Logistic regression was used to analyse OAC prescription, while the risk of OAC discontinuation and adverse outcomes were analysed through Cox-regression model. Our primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). The original studies were registered with ClinicalTrials.gov, NCT01468701, NCT01671007, and NCT01937377. Findings: 34,421 patients were included (70.0 ± 10.5 years, 45.1% females, 6900 (20.0%) Asian: 3829 (55.5%) Chinese, 814 (11.8%) Japanese, 1964 (28.5%) Korean and 293 (4.2%) other Asian). Most of the Asian patients were recruited in Asia (n = 6701, 97.1%), while non-Asian patients were mainly recruited in Europe (n = 15,449, 56.1%) and North America (n = 8378, 30.4%). Compared to non-Asian individuals, prescription of OAC and non-vitamin K antagonist oral anticoagulant (NOAC) was lower in Asian patients (Odds Ratio [OR] and 95% Confidence Intervals (CI): 0.23 [0.22-0.25] and 0.66 [0.61-0.71], respectively), but higher in the Japanese subgroup. Asian ethnicity was also associated with higher risk of OAC discontinuation (Hazard Ratio [HR] and [95% CI]: 1.79 [1.67-1.92]), and lower risk of the primary composite outcome (HR [95% CI]: 0.86 [0.76-0.96]). Among the exploratory secondary outcomes, Asian ethnicity was associated with higher risks of thromboembolism and intracranial haemorrhage, and lower risk of major bleeding. Interpretation: Our results showed that Asian patients with AF showed suboptimal thromboembolic risk management and a specific risk profile of adverse outcomes; these differences may also reflect differences in country-specific factors. Ensuring integrated and appropriate treatment of these patients is crucial to improve their prognosis. Funding: The GLORIA-AF Registry was funded by Boehringer Ingelheim GmbH

Search for supersymmetric partners of electrons and muons in proton–proton collisions at s=13TeV

A search for direct production of the supersymmetric (SUSY) partners of electrons or muons is presented in final states with two opposite-charge, same-flavour leptons (electrons and muons), no jets, and large missing transverse momentum. The data sample corresponds to an integrated luminosity of 35.9 fb−1 of proton–proton collisions at s=13TeV, collected with the CMS detector at the LHC in 2016. The search uses the MT2 variable, which generalises the transverse mass for systems with two invisible objects and provides a discrimination against standard model backgrounds containing W bosons. The observed yields are consistent with the expectations from the standard model. The search is interpreted in the context of simplified SUSY models and probes slepton masses up to approximately 290, 400, and 450 GeV, assuming right-handed only, left-handed only, and both right- and left-handed sleptons (mass degenerate selectrons and smuons), and a massless lightest supersymmetric particle. Limits are also set on selectrons and smuons separately. These limits show an improvement on the existing limits of approximately 150 GeV.0info:eu-repo/semantics/publishe