The evolution of income-related inequalities in health care utilization in Switzerland over time

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996health care utilization; inequality

The evolution of income-related health inequalities in Switzerland over time

This paper presents new evidence on income-related health inequality and its development over time in Switzerland. We employ the methods lined out in van Doorslaer and Jones (2003) and van Doorslaer and Koolman (2004) measuring health using an interval regression approach to compute concentration indices and decomposing inequality into its determining factors. Nationally representative survey data for 1982, 1992, 1997 and 2002 are used to carry out the analysis. Looking at each of the four years separately the results indicates the usual positive relationship between income and health, but the distribution is among the least unequal in Europe. No clear trend emerges in the evolution of the inequality indices over the two decades. Inequality is somewhat lower in 1982 and 1992 as compared to 1997 and 2002 but the differences are not significant. The most important contributors to health inequality are income, education and activity status, in particular retirement. Regional differences including the widely varying health care supply, by contrast, do not exert any systematic influenceInequalities in health; concentration index; decomposition analysis

The evolution of income-related inequalities in health care utilization in Switzerland over time

This study investigates equity in access to health care in Switzerland over time, using nationwide representative survey data from 1982, 1992, 1997 and 2002. Both simple quintile distributions and concentration indices are used to assess horizontal equity, i.e. the extent to which adults in equal need for medical care appear to have equal rates of medical care utilization. Looking at each of the four survey years separately the results indicate that by and large, there is little or no inequity in use except with respect to specialist visits which are clearly pro rich distributed as in most other OECD countries. We neither find much significant variation over time despite the fact that the share of health care has grown from close to 8% to more than 11% over this period and that a major reform of the health care system has taken place in 1996

The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets

Compares systems of universal insurance coverage based on individual mandates, consumer choice of health plans, and regulated insurance market competition in Switzerland and the Netherlands. Discusses insights and implications for U.S. reform efforts

Freeform Extrusion of High Solids Loading Ceramic Slurries, Part I: Extrusion Process Modeling

A novel solid freeform fabrication method has been developed for the manufacture of ceramic-based components in an environmentally friendly fashion. The method is based on the extrusion of ceramic slurries using water as the binding media. Aluminum oxide (Al2O3) is currently being used as the part material and solids loading as high as 60 vol. % has been achieved. This paper describes a manufacturing machine that has been developed for the extrusion of high solids loading ceramic slurries. A critical component of the machine is the deposition system, which consists of a syringe, a plunger, a ram actuated by a motor that forces the plunger down to extrude material, and a load cell to measure the extrusion force. An empirical, dynamic model of the ceramic extrusion process, where the input is the commanded ram velocity and the output is the extrusion force, is developed. Several experiments are conducted and empirical modeling techniques are utilized to construct the dynamic model. The results demonstrate that the ceramic extrusion process has a very slow dynamic response, as compared to other non-compressible fluids such as water. A substantial amount of variation exists in the ceramic extrusion process, most notably in the transient dynamics, and a constant ram velocity may either produce a relatively constant steady-state extrusion force or it may cause the extrusion force to steadily increase until the ram motor skips. The ceramic extrusion process is also subjected to significant disturbances such as air bubble release, which causes a dramatic decrease in the extrusion force, and nozzle clogging, which causes the extrusion force to slowly increase until the clog is released or the ram motor skips.Mechanical Engineerin

Freeform Extrusion of High Solids Loading Ceramic Slurries, Part II: Extrusion Process Control

Part I of this paper provided a detailed description of a novel fabrication machine for high solids loading ceramic slurry extrusion and presented an empirical model of the ceramic extrusion process, with ram velocity as the input and extrusion force as the output. A constant force is desirable in freeform extrusion processes as it correlates with a constant material deposition rate and, thus, good part quality. The experimental results in Part I demonstrated that a constant ram velocity will produce a transient extrusion force. In some instances the extrusion force increased until ram motor skipping occurred. Further, process disturbances, such as air bubble release and nozzle clogging that cause sudden changes in extrusion force, were often present. In this paper a feedback controller for the ceramic extrusion process is designed and experimentally implemented. The controller intelligently adjusts the ram motor velocity to maintain a constant extrusion force. Since there is tremendous variability in the extrusion process characteristics, an on-off controller is utilized in this paper. Comparisons are made between parts fabricated with and without the feedback control. It is demonstrated that the use of the feedback control reduces the effect of process disturbances (i.e., air bubble release and nozzle clogging) and dramatically improves part quality.Mechanical Engineerin

Aqueous-Based Extrusion Fabrication of Ceramics on Demand

Aqueous-Based Extrusion Fabrication is an additive manufacturing technique that extrudes ceramic slurries of high solids loading layer by layer for part fabrication. The material reservoir in a previously developed system has been modified to allow for starting and stopping of the extrusion process on demand. Design pros and cons are examined and a comparison between two material reservoir designs is made. Tests are conducted to determine the optimal deposition parameters for starting and stopping the extrudate on demand. The collected test data is used for the development of a deposition strategy that improves material deposition consistency, including reduced material buildup at sharp corners. Example parts are fabricated using the deposition strategy and hardware design.Mechanical Engineerin

Statistical aspects of the TNK-S2B trial of tenecteplase versus alteplase in acute ischemic stroke: an efficient, dose-adaptive, seamless phase II/III design

Background TNK-S2B, an innovative, randomized, seamless phase II/III trial of tenecteplase versus rt-PA for acute ischemic stroke, terminated for slow enrollment before regulatory approval of use of phase II patients in phase III