The German social long-term care insurance - structure and reform options

Regarding social needs in Germany long-term care is an important issue due to an ageing population. Shrinking social networks are leading to a greater need for a public long-term care system. In 1995 the social long-term care insurance was introduced in Germany which is similar in nature to the other social insurances, such as the health care or pension insurance. Long-term care insurance funds are generally linked to health insurance funds. The benefits are financed by virtue of an income-based system where all employees covered by the social security system and their employers have to pay equal contributions on a pay-as-you-go basis. In case of long-term care needs a frail person is assigned to one of three care levels according to his/her severity of need. Benefit recipients living in private households can choose between three kinds of transfers: in-kind transfers, lump-sum transfers and combined transfers whereas the amount of in-kind transfers is higher than the lump-sum transfers in all care levels. Benefit recipients living in nursing homes receive the highest amount of transfers. In recent years some drawbacks of the social long-term care insurance structure turned out to be in need of reform: While health insurance is a fully comprehensive system, long-term care insurance only provides limited cover. Therefore, insurance funds have an incentive to shift some services from health care to long-term care insurance. For instance, there is a low incentive to provide rehabilitation measures in order to lower the care level. Additionally, there is no free competition on the long-term care market because care packages included in the in-kind transfers are negotiated (with respect to services and prices) between insurance funds and professional care providers. Finally, the financial situation of the German social long-term care insurance is tight. While in the first years after introduction the net results of revenues and expenditures were positive they have been negative since 1999 which is due to an increasing number of benefit recipients. Therefore, we discuss several reform options which have been proposed in order to overcome the financial and structural problems. Suggestions for the income side include the introduction of fixed premiums, a fully funded system, a private insurance, or a citizens? insurance. The main problem here is to finance the transition from one system to another system. Some proposals are discussed here. The introduction of individual budgets is the most popular option for the outcome side. A social experiment is under way in order to evaluate the impact of so-called matching transfers. --

The German Social Long-Term Care Insurance – Structure and Reform Options

In recent years some drawbacks of the social long-term care insurance structure in Germany turned out to be in need of reform.: While health insurance is a fully comprehensive system, long-term care insurance only provides limited cover. Therefore, insurance funds have an incentive to shift some services from health care to long-term care insurance. Additionally, there is no free competition on the long-term care market. Finally, the financial situation of the German social long-term care insurance is tight, because of the increasing number of benefit recipients. Therefore, we discuss several reform options which have been proposed in order to overcome the financial and structural problems. Suggestions for the income side include the introduction of fixed premiums, a fully funded system, a private insurance, or a citizens’ insurance. The main problem here is to finance the transition from one system to another system. Some proposals are discussed here. The introduction of individual budgets is the most popular option for the outcome side. A social experiment is under way in order to evaluate the impact of so-called matching transfers

Fragmentable Heterogeneous Cocatalysts for the Metallocene-Catalyzed Polymerization of Olefins, II [1]. Preparation, Characterization and Testing of the Cocatalysts and Microscopic Evaluation of the Polyethylene

Surface modified silica were reacted with different aluminiumalkyls AlR2R’ (R = Me, Et, i-Bu, R’ = H, Me, Et, i-Bu), oligomeric methylaluminoxane (MAO) and combinations of both, to yield heterogeneous cocatalysts. These cocatalyts were employed to polymerize ethylene using zirconocene dichloride as the catalyst. The polymerization activity profiles have been recorded and compared with the information gained from the scanning electron microscopy (SEM) images of the polymers. The fragmentation of the heterogeneous cocatalyts upon polymerization has been demonstrated. The degree of fragmentation and the polymerization activity depend on the preparation of the silica supports and on the preparation of the heterogeneous cocatalysts using these supports. The most reactive, fragmentable heterogeneous cocatalysts show polymerization activities slightly higher than MAO in homogeneous solution and almost 1.5 times higher than commercially available MAO on silica (=MAO on Sylopol).BMBF, 03C0295, Verbundprojekt: Heterogene und homogene Cokatalysatoren und Katalysatoren für die OlefinpolymerisationDFG, GRK 352, Synthetische, mechanistische und reaktionstechnische Aspekte von Metallkatalysatore

Fragmentable Heterogeneous Cocatalysts for the Metallocene-Catalyzed Polymerization of Olefins, I. Surface Modification of Silica and Characterization of the Resulting Carriers

Surface modification of pre-dried spherical silica nano-particles with diameters of 235 nm and 10 to 20 nm and of commercially available non-spherical silica materials using various aminoalkyltrialkoxysilanes and α-ω-bis(alkoxysilyl)organyls (organyl = alkanediyl, aminoalkanediyl, polyether, polysiloxane) has been performed in suspension in solvents with water. The quantity of water has a dominating influence, as compared to the amounts and the ratios of silanes employed, on the surface morphology of the modified silicas. The morphologies observed range from weakly linked aggregates of spherical particles to large agglomerates covered by thick irregular layers of organopolysiloxane, as demonstrated by scanning electron microscopy. These carriers can be modified further with organoaluminium compounds to yield heterogeneous cocatalysts for the polymerization of ethylene.BMBF, 03C0295, Verbundprojekt: Heterogene und homogene Cokatalysatoren und Katalysatoren für die OlefinpolymerisationDFG, GRK 352, Synthetische, mechanistische und reaktionstechnische Aspekte von Metallkatalysatore

Interventional treatment in diabetics in the era of drugeluting stents and compliance to the ESC guidelines: Lessons learned from the Euro Heart Survey Programme

Aims: The objective of the study is to determine the demographics and the in-hospital outcome of diabetic and non-diabetic patients treated with percutaneous coronary interventions (PCI) in Europe, to report the type of equipment and technology used for PCI procedures in diabetics and to clarify whether the treatment of diabetic patients complies with current European Society of Cardiology (ESC) guidelines. Methods and results: A total of 14,458 patients treated with PCI were enrolled from 29 member countries of the ESC between June 2005 and January 2006. Data were collected on patient characteristics and treatment, using new Cardiology Audit and Registration Data standards. In total, 3,603 patients (24.9%) were diabetic. Diabetics were older, more often female and had a higher body mass index than non-diabetics. Diabetics had higher rates of hypercholesterolaemia and hypertension, while current smokers were more frequent in the non-diabetics. Diabetics also had significantly higher rates of previous cardiovascular events. Clopidogrel was administered only in 48.1% of diabetic patients before PCI, while IIb/IIIa inhibitors were 22.9% during PCI. At discharge, there was a major adjustment of treatment with increases in the use of Beta-blocker (80.4%), angiotensin converting enzyme inhibitor (ACEI, 71.3%) and statins (89.8%) compared with on admission (Beta-blocker 60.9%, ACEI 55.0%, statin 63.1%). Inhospital mortality was higher in diabetics (1.8% vs 1.2%) although the in-hospital MACCE rate was not significantly different (3.6% vs 3.0%, p=0.09). Conclusions: Diabetic patients treated with PCI were older with more comorbidity. According to ESC guideline, the under-usage of clopidogrel, GP IIb/IIIa inhibitors should be improved. PCI is now taken as a good opportunity to adjust the use of appropriate medication. © Europa Edition. All rights reserved