Auf dem Wege zu einer integrierten Versorgung: Neue sozialrechtliche Rahmenbedingungen unter Berücksichtigung der Erfahrungen aus den USA und am Beispiel Berlins

Die vollzogene Gesundheitsreform eröffnet im Rahmen des Sozialgesetzbuches neue Möglichkeiten für Managed Care Lösungen. Bislang basierte das System auf Kollektivverträgen während Managed Care selektives Kontrahieren von Versicherungen mit Leistungsanbietern vorsieht. Im Ergebnis soll der Wettbewerb zwischen den Krankenversicherungen verstärkt werden. Die Einführung von zusätzlichen Wettbewerbselementen soll eine kostengünstigere und dennoch qualitativ hochwertige Versorgung sicherstellen. In den USA ist ein Grossteil der Bevölkerung in unterschiedlichen Formen von Managed Care Organisationen versichert, deshalb soll eine kritische Analyse der amerikanischen Erfahrungen beispielhaft in die Arbeit einfließen. Kosteneinsparungen konnten dort nur mit Hilfe eines durchgängigen Managed Care Systems erreicht werden. Im Rahmen der Arbeit soll untersucht werden, inwiefern eine Managed Care Organisation in Berlin implementiert werden könnte. Als Region soll dabei der innere S-Bahnring der Stadt Berlin dienen. Dort gibt es genügend Leistungserbringer, die zu einem Netzwerk verbunden werden könnten. Als Rechtsrahmen wird eine GmbH-Lösung empfohlen. -- The latest health care reform in German provides a new codification of the social law and framework that creates the base for a managed care. Up to now social security was characterised by collective agreements whereas managed care consists of a number of selective agreements between insurance companies and providers of medical services. As a result competition between the providers should be increased. The introduction of additional market elements should improve the co-ordination of the single providers. This is for the purpose to offer a high-grade health service at lower costs. In the United States a greater part of the population is enrolled in a Managed Care Organisation (MCO) and that is why it served as an example to be critically reviewed. A reduction of costs can only be realised when the Managed Care idea dominates all sectors of public health service and a consistent system can be founded. The present work examines the possibilities to implement a MCO in Berlin. The inner circle of the Berlin urban railway (S-Bahn) is an ideal location for the MCO. Favourable are a relatively low age of local population and a high level of education. Both criteria are correlated with a low demand of health services. Moreover in the mentioned area already exists a certain number of hospitals and medical service points that could be united to a network. The legal form of a GmbH (Ltd.) fits best for this purpose.

Observations of the Diurnal Dependence of the High-Latitude \u3ci\u3eF\u3c/i\u3e Region Ion Density by DMSP Satellites

Data from the DMSP F2 and F4 satellites for the period December 5-10, 1979, have been used to study the diurnal dependence of the high-latitude ion density at 800-km altitude. A 24-hour periodicity in the minimum orbital density (MOD) during a crossing of the high-latitude region is observed in both the winter and summer hemispheres. The phase of the variation in MOD is such that it has a minimum during the 24-hour period between 0700 and 0900 UT. Both the long term variation of the high-latitude ion density on a time scale of days, and the orbit by orbit variations at the same geomagnetic location in the northern (winter) hemisphere for the magnetically quiet time period chosen show good qualitative agreement with the diurnal dependence predicted by a theoretical model of the ionospheric density at high latitudes under conditions of low convection speeds (Sojka et al., 1981a)

The First Empirical Mass Loss Law for Population II Giants

Using the Spitzer IRAC camera we have obtained mid-IR photometry of the red giant branch stars in the Galactic globular cluster 47 Tuc. About 100 stars show an excess of mid-infrared light above that expected from their photospheric emission. This is plausibly due to dust formation in mass flowing from these stars. This mass loss extends down to the level of the horizontal branch and increases with luminosity. The mass loss is episodic, occurring in only a fraction of stars at a given luminosity. Using a simple model and our observations we derive mass loss rates for these stars. Finally, we obtain the first empirical mass loss formula calibrated with observations of Population II stars. The dependence on luminosity of our mass loss rate is considerably shallower than the widely used Reimers Law. The results presented here are the first from our Spitzer survey of a carefully chosen sample of 17 Galactic Globular Clusters, spanning the entire metallicity range from about one hundredth up to almost solar

PAndAS in the mist: The stellar and gaseous mass within the halos of M31 and M33

Large scale surveys of the prominent members of the Local Group have provided compelling evidence for the hierarchical formation of massive galaxies, revealing a wealth of substructure that is thought to be the debris from ancient and on-going accretion events. In this paper, we compare two extant surveys of the M31-M33 subgroup of galaxies; the Pan-Andromeda Archaeological Survey (PAndAS) of the stellar structure, and a combination of observations of the HI gaseous content, detected at 21cm. Our key finding is a marked lack of spatial correlation between these two components on all scales, with only a few potential overlaps between stars and gas.The paucity of spatial correlation significantly restricts the analysis of kinematic correlations, although there does appear to the HI kinematically associated with the Giant Stellar Stream where it passes the disk of M31. These results demonstrate that that different processes must significantly influence the dynamical evolution of the stellar and HI components of substructures, such as ram pressure driving gas away from a purely gravitational path. Detailed modelling of the offset between the stellar and gaseous substructure will provide a determination of the properties of the gaseous halo of M31 and M33.Comment: 11 pages, 6 figures. Accepted for publication in the Astrophysical Journal. Figure quality reduced. High quality version available at http://www.physics.usyd.edu.au/~gfl/Arxiv_Papers/PAndAS_Mist