Transfer Payment Systems and Financial Distress: Insights from Health Insurance Premium Subsidies

How should payment systems of means-tested benefits be designed to improve the financial situation of needy recipients most effectively? We study this question in the context of mandatory health insurance in Switzerland, where recipients initially received either a cash transfer or subsidized insurance premiums (a form of in-kind transfer). A federal reform in 2014 forced cantons (i.e. states) to universally switch to in-kind provision. We exploit this setting based on a difference-in-differences design, analyzing rich individual-level accounting data and applying a machine learning approach to identify cash recipients prior to the reform. We find that switching from cash to in-kind transfers reduces the likelihood of late premiums payments by about 20% and of government debt collection for long-term missed payments by approximately 16%. There is no evidence for a negative spillover effect on the timely payment of the non-subsidized coinsurance bills for health services after the regime change

Organic Action Plans. Development, implementation and evaluation. A resource manual for the organic food and farming sector

In 2004, the European Action Plan for Organic Food and Farming was launched. Many European countries have also developed national Organic Action Plans to promote and support organic agriculture. As part of the EU funded ORGAP project (“European Action Plan of Organic Food and Farming - Development of criteria and procedures for the evaluation of the EU Action Plan for Organic Agriculture”) a toolbox to evaluate and monitor the implementation of national and European Action Plans has been developed. In order to communicate the results of this project as widely as possible, a practical manual for initiating and evaluating Organic Action Plans has been produced. This manual has been created to inspire the people, organisations and institutions involved, or with an interest, in the organic food and farming sector to engage in the initiation, review, revision and renewal of regional, national and European Organic Action Plans. The objectives of the manual are to provide: • a tool for stakeholder involvement in future Action Plan development and implementation processes at EU, national and regional level • a guide to the use of the Organic Action Plan Evaluation Toolbox (ORGAPET) developed through the project The manual summarises the key lessons learnt from more than 10 years experience of development, implementation and evaluation of Organic Action Plans throughout Europe. The Organic Action Plan Evaluation Toolbox (ORGAPET), which includes comprehensive information to support the Organic Action Plan development and evaluation process is included with the manual as a CD-ROM, and is also accessible on-line at www.orgap.org/orgapet. The ORGAP website www.orgap.org provides a further information on the project and the European and national organic action plans. Published by: Research Institute of Organic Agriculture (FiBL), Frick, Switzerland; IFOAM EU Group, Brussels Table of contents Foreword 1 1 Introduction 3 1.1 About this manual 3 1.2 Organic farming – origins, definition & principles 6 1.3 Development of organic food & farming in Europe 8 1.3.1 Organic food and farming regulation in Europe 10 1.3.2 Policy support for organic food and farming in Europe 11 2 Organic Action Plans – what are they about? 16 2.1 Why Organic Action Plans? 16 2.2 European Organic Action Plan 21 2.3 Overview of national and regional Organic Action Plans 23 3 Planning and implementing Organic Action Plans 28 3.1 Policy development 28 3.2 Defining organic sector development needs and potential 31 3.3 Defining policy goals and objectives 34 3.4 Involving stakeholders 40 3.4.1 The case for stakeholder involvement 40 3.4.2 Identifying relevant stakeholders 42 3.4.3 Participatory approaches for stakeholders involvement 44 3.5 Decision making: selecting, integrating and prioritising relevant measures 46 3.5.1 Deciding on policy instruments and action points 47 3.5.2 Priorities for action – allocating resources 50 3.6 Implementing Organic Action Plans 52 3.7 Including monitoring and evaluation of Organic Action Plans from outset 56 3.8 Managing communication 58 3.9 Development of Action Plans in countries that joined the EU in 2004 and later 59 4 Evaluating Organic Action Plans 61 4.1 Principles of evaluation 61 4.2 Conducting an evaluation 64 4.3 Evaluating Action Plan design and implementation 70 4.3.1 Evaluating programme design and implementation processes 70 4.3.2 Evaluating programme coherence 72 4.3.3 Evaluating stakeholder involvement 74 4.4 Evaluating Action Plan effects 78 4.4.1 Developing and using indicators for evaluation 78 4.5 Overall evaluation of Organic Action Plans – judging success 85 4.6 Evaluating Action Plans in countries that joined the EU in 2004 and later 89 5 Organic Action Plans – the Golden Rules 91 5.1 Key elements of Organic Action Plan development 91 5.2 The Golden rules for Organic Action Plan 93 References 96 Annex Detailed synopsis of ORGAPET 10

Mesoscopic simulations of the counterion-induced electroosmotic flow - a comparative study

We present mesoscopic simulations of the counterion-induced electroosmotic flow in different electrostatic coupling regimes. Two simulation methods are compared, Dissipative Particle Dynamics (DPD) and coupled Lattice-Boltzmann/Molecular Dynamics (LB/MD). A general mapping scheme to match DPD to LB/MD is developed. For the weak-coupling regime, analytic expressions for the flow profiles in the presence of partial-slip as well as no-slip boundary conditions are derived from the Poisson-Boltzmann and Stokes equations, which are in good agreement with the numerical results. The influence of electrofriction and partial slip on the flow profiles is discussed.Comment: 10 pages, 8 figures, 3 tables, additional references and minor changes in the tex

Antidiabetic Medication Utilisation before and during Pregnancy in Switzerland between 2012 and 2019: An Administrative Claim Database from the MAMA Cohort.

BACKGROUND The incidence of diabetes mellitus (both pregestational and gestational) is increasing worldwide, and hyperglycemia during pregnancy is associated with adverse pregnancy outcomes. Evidence on the safety and efficacy of metformin during pregnancy has accumulated resulting in an increase in its prescription in many reports. AIMS We aimed to determine the prevalence of antidiabetic drug use (insulins and blood glucose-lowering drugs) before and during pregnancy in Switzerland and the changes therein during pregnancy and over time. METHODS We conducted a descriptive study using Swiss health insurance claims (2012-2019). We established the MAMA cohort by identifying deliveries and estimating the last menstrual period. We identified claims for any antidiabetic medication (ADM), insulins, blood glucose-lowering drugs, and individual substances within each class. We defined three groups of pattern use based on timing of dispensation: (1) dispensation of at least one ADM in the prepregnancy period and in or after trimester 2 (T2) (pregestational diabetes); (2) dispensation for the first time in or after T2 (GDM); and (3) dispensation in the prepregnancy period and no dispensation in or after T2 (discontinuers). Within the pregestational diabetes group, we further defined continuers (dispensation for the same group of ADM) and switchers (different ADM group dispensed in the prepregnancy period and in or after T2). RESULTS MAMA included 104,098 deliveries with a mean maternal age at delivery of 31.7. Antidiabetic dispensations among pregnancies with pregestational and gestational diabetes increased over time. Insulin was the most dispensed medication for both diseases. Between 2017 and 2019, less than 10% of pregnancies treated for pregestational diabetes continued metformin rather than switching to insulin. Metformin was offered to less than 2% of pregnancies to treat gestational diabetes (2017-2019). CONCLUSION Despite its position in the guidelines and the attractive alternative that metformin represents to patients who may encounter barriers with insulin therapy, there was reluctance to prescribe it

Plans d’action pour l’agriculture biologique. Développement, mise en œuvre et évaluation. Un manuel de ressources pour le secteur de l’alimentation et de l’agriculture biologiques

Avant-propos La Commission européenne a publié en juin 2004 le Plan d’action européen pour l’alimentation et l’agriculture biologiques. Avec ce plan, la Commission visait à évaluer la situation de l’agriculture biologique et à fonder les bases de développement de sa politique future. Au niveau national, de nombreux gouvernements ont également développé des plans d’action pour promouvoir l’agriculture biologique. Il est donc apparu nécessaire de considérer comment de tels plans d’action pouvaient être évalués avec succès. Le plan d’action européen a été la motivation principale pour la DG Recherche de la Commission européenne de financer un projet de soutien spécifique, l’ORGAP, Projet No. CT-2005-006591 au sein du 6ème programme-cadre de recherche. Ce projet, intitulé “Plan d’action européen pour l’alimentation et l’agriculture biologiques – développement de critères et de procédures d’évaluation du Plan d’action UE pour l’agriculture biologique”, a débuté en mai 2005 et s’est terminé en avril 2008. Des outils ont été développés au sein du projet pour évaluer et surveiller la mise en œuvre du Plan d’action européen dans les domaines suivants : information, formation et pédagogie, recherche, production, traitement, développement du marché, certification et dépenses publiques. Ces outils ont été testés sur un échantillon de Plans d’action nationaux existants, et pour partie aussi sur le Plan d’action européen, en plaçant principalement l’accent sur les processus de mise en œuvre. En outre, des recommandations politiques de la Commission européenne, des autorités nationales et autres acteurs ont été émises. Afin de communiquer les recommandations relatives à ce projet aussi largement que possible, ce manuel pratique d’initiation et d’évaluation des plans d’action a été créé. La fonction de ce manuel est double : a) Outil de participation des acteurs dans le développement de futurs plans et mise en œuvre au niveau UE, national et régional ; b) Guide d’utilisation d’ORGAPET, des outils d’évaluation du projet ORGAP (fourni sur CD-ROM avec le manuel et disponible en ligne sur le site www.orgap.org). Le manuel, créé dans le cadre du projet ORGAP, est largement basé sur les documents inclus dans l’Organic Action Plan Évaluation Toolbox (Outils d’évaluation du plan d’action biologique) (ORGAPET). Les institutions suivantes ont contribué au développement d’ORGAPET et du manuel : - Université de Hohenheim (UHO), Stuttgart (Prof. Stephan Dabbert, Christian Eichert) ; - Aberystwyth University (UWA), Pays de Galles, Grande-Bretagne (Dr. Nic Lampkin, Ian Jeffreys) ; - Polytechnic University of Marche, Ancona (UNIVPM), Italie (Prof. Raffaele Zanoli, Dr. Daniela Vairo) ; - University of Southern Denmark (USD), Danemark (Dr. Johannes Michelsen)

Effectiveness of a 10-Day Melarsoprol Schedule for the Treatment of Late-Stage Human African Trypanosomiasis: Confirmation from a Multinational Study (Impamel II)

BackgroundTreatment of late-stage human African trypanosomiasis (HAT) with melarsoprol can be improved by shortening the regimen. A previous trial demonstrated the safety and efficacy of a 10-day treatment schedule. We demonstrate the effectiveness of this schedule in a noncontrolled, multinational drug-utilization study MethodsA total of 2020 patients with late-stage HAT were treated with the 10-day melarsoprol schedule in 16 centers in 7 African countries. We assessed outcome on the basis of major adverse events and the cure rate after treatment and during 2 years of follow-up ResultsThe cure rate 24 h after treatment was 93.9%; 2 years later, it was 86.2%. However, 49.3% of patients were lost to follow-up. The overall fatality rate was 5.9%. Of treated patients, 8.7% had an encephalopathic syndrome that was fatal 45.5% of the time. The rate of severe bullous and maculopapular eruptions was 0.8% and 6.8%, respectively ConclusionsThe 10-day treatment schedule was well implemented in the field and was effective. It reduces treatment duration, drug amount, and hospitalization costs per patient, and it increases treatment-center capacity. The shorter protocol has been recommended by the International Scientific Council for Trypanosomiasis Research and Control for the treatment of late-stage HAT caused by Trypanosoma brucei gambiens

Colorectal cancer testing rates after implementation of an organised screening programme in Vaud, Switzerland

AIMS OF THE STUDY: Canton Vaud, Switzerland, implemented an organised colorectal cancer  screening programme with colonoscopy and faecal occult blood tests in 2015, 4 to 6 years ahead of neighbouring cantons. Before its implementation, nearly half of Swiss citizens were already up to date with screening, primarily from opportunistic colonoscopies. We hypothesised that earlier implementation of an organised programme would be associated with greater increases in colorectal cancer testing rates. METHODS: We analysed Swiss health insurance claim data from CSS, a Swiss health insurer covering 16% of the Swiss population and 10% of canton Vaud. We stratified 50–69-year-olds into groups from Vaud, its four neighbouring cantons (Fribourg, Geneva, Neuchâtel and Valais), and the rest of Switzerland. We analysed overall, faecal occult blood test and colonoscopy testing rates for each year between 2010 and 2018. RESULTS: The overall testing rate increased from 7.6% in 2010 to 11.6% in 2018 (+4.0%) in Vaud, from 6.1% to 9.3% (+3.2%) in neighbouring cantons and from 7.4% to 8.6% (+1.2%) in the rest of Switzerland. The faecal occult blood test rate increased between 2016 and 2018 from 2.9% to 4.1% (+1.2%) in Vaud and from 1.7% to 2.6% (+0.9%) in neighbouring cantons, but it decreased from 3.1% to 1.5% (–1.6%) in the rest of Switzerland. The colonoscopy rate increased in all cantons, from 4.7% to 7.5% in Vaud (+2.8%), from 4.4% to 6.7% in neighbouring cantons (+2.3%) and from 4.3% to 7.1% in the rest of Switzerland (+2.8%). By 2018, 40% of faecal occult blood tests and 26% of colonoscopies in Vaud occurred in the organised programme. Those who completed an faecal occult blood test within the Vaud programme were younger, had fewer comorbidities and were more likely to have a high-deductible health plan than those tested outside the programme. CONCLUSIONS: Colorectal cancer testing rates increased between 2010 and 2018, with greater absolute increases in Vaud than in neighbouring cantons or the rest of Switzerland. Faecal occult blood test use increased in both Vaud and neighbouring cantons, possibly reflecting changes in testing patterns by general practitioners. By 2018, 40% of colonoscopies and 26% of faecal occult blood tests occurred within the screening programme

Change in colorectal cancer (CRC) testing rates associated with the introduction of the first organized screening program in canton Uri, Switzerland: Evidence from insurance claims data analyses from 2010 to 2018.

The first canton in Switzerland to implement an organized colorectal cancer screening program (OSP) was Uri. Starting in 2013, it offered 50-69-year-olds free testing with colonoscopy every 10 years or fecal occult blood test (FOBT) every 2 years. We tested the association between the OSP and testing rates over time. We analyzed claims data of 50-69-year-olds from Uri and neighboring cantons (NB) provided by a large health insurance and complemented it with data from the OSP. We fitted multivariate adjusted logistic regression models to compare overall testing rates and by method (colonoscopy or FOBT/both) We computed the 2018 rate of the population up-to-date with testing (colonoscopy within 9 years/FOBT within 2 years). Yearly overall testing rates in Uri increased from 8.7% in 2010 to 10.8% in 2018 and from 6.5% to 7.9% in NB. In Uri, the proportion tested with FOBT/both increased from 4.7% to 6.0% but decreased from 2.8% to 1.1% in NB. Testing by FOBT/both increased more between 2015 and 2018 than 2010-2012 in Uri than in NB (OR:2.1[95%CI:1.8-2.4]), it increased less for colonoscopy (OR:0.60[95%CI:0.51-0.70]), with no change in overall CRC testing (OR:0.91[95%CI:0.81-1.02]). In 2018 in Uri, 42.5% were up-to-date with testing (FOBT/both:9.2%, colonoscopy:35.7%); in NBs, 40.7% (FOBT/both:2.7%, colonoscopy:39%). Yearly FOBT rates in Uri were always higher than in NB. Though the OSP in Uri was not associated with a greater increase in overall testing rates, the OSP was associated with increased FOBT

Preoperative radiological characterization of hepatic angiomyolipoma using magnetic resonance imaging and contrast-enhanced ultrasonography: a case report

<p>Abstract</p> <p>Introduction</p> <p>A hepatic angiomyolipoma is a rare benign tumor of the liver composed of a mixture of smooth muscle cells, blood vessels and a variable amount of adipose tissue. Differentiating them from malignant liver tumors can often be very difficult.</p> <p>Case presentation</p> <p>We report the case of a 43-year-old Caucasian man presenting with a large liver mass in the right lobe. The results of magnetic resonance imaging and contrast-enhanced ultrasonography were consistent with a well-demarcated adipose tissue- containing tumor, showing prolonged hyperperfusion in comparison with the surrounding liver tissue. Surgery was performed and the diagnosis of hepatic angiomyolipoma was made with histopathology.</p> <p>Conclusion</p> <p>Preoperative radiological characterization using magnetic resonance imaging and contrast-enhanced ultrasonography may improve diagnostic accuracy of hepatic angiomyolipoma. Identification of smooth muscle cells, blood vessels and adipose tissue with a positive immunohistochemical reaction for HMB-45 is the final evidence for an angiomyolipoma.</p

A "Combination Nova" Outburst in Z Andromedae: Nuclear Shell Burning Triggered by a Disk Instability

We describe observational evidence for a new kind of interacting-binary-star outburst that involves both an accretion instability and an increase in thermonuclear shell burning on the surface of an accreting white dwarf. We refer to this new type of eruption as a combination nova. In late 2000, the prototypical symbiotic star Z Andromedae brightened by roughly two magnitudes in the optical. We observed the outburst in the radio with the VLA and MERLIN, in the optical both photometrically and spectroscopically, in the far ultraviolet with FUSE, and in the X-rays with both Chandra and XMM. The two-year-long event had three distinct stages. During the first stage, the optical rise closely resembled an earlier, small outburst that was caused by an accretion-disk instability. In the second stage, the hot component ejected an optically thick shell of material. In the third stage, the shell cleared to reveal a white dwarf whose luminosity remained on the order of 10^4 Lsun for approximately one year. The eruption was thus too energetic to have been powered by accretion alone. We propose that the initial burst of accretion was large enough to trigger enhanced nuclear burning on the surface of the white dwarf and the ejection of an optically thick shell of material. This outburst therefore combined elements of both a dwarf nova and a classical nova. Our results have implications for the long-standing problem of producing shell flashes with short recurrence times on low-mass white dwarfs in symbiotic stars.Comment: Accepted for publication in ApJ. 24 pages, 10 figure