Direct versus indirect standardization in risk adjustment.

Direct and indirect standardization procedures aim at comparing differences in health or differences in health care expenditures between subgroups of the population after controlling for observable morbidity differences. There is a close analogy between this problem and the issue of risk adjustment in health insurance. We analyse this analogy within the theoretical framework proposed in the recent social choice literature on responsibility and compensation. Traditional methods of risk adjustment are analogous to indirect standardization. They are equivalent to the so-called conditional egalitarian mechanism in social choice. In general, they do not remove incentives for risk selection, even if the effect of non-morbidity variables is correctly taken into account. A method of risk adjustment based on direct standardization (as proposed for Ireland) does remove the incentives for risk selection, but at the cost of violating a neutrality condition, stating that insurers should receive the same premium subsidy for all members of the same risk group. Direct standardization is equivalent to the egalitarianequivalent (or proportional) mechanism in social choice. The conflict between removing incentives for risk selection and neutrality is unavoidable if the health expenditure function is not additively separable in the morbidity and efficiency variables.Costs; Cost; Risk; Policy; Choice; Insurance; Equality; Belgium;

Supplemental health insurance and equality of access in Belgium.

It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.Costs; Cost; Risk; Policy; Choice; Insurance; Equality; Belgium;

Maximumfactuur en kleine risico’s: verdeling van de eigen bijdragen voor gezondheidszorg in België

Overal in Europa komt de financiering van publieke systemen van ziekteverzekering of gezondheidszorg onder druk door de sterke stijging van de uitgaven. België ontsnapt niet aan deze evolutie. De stijging van de uitgaven voor gezondheidszorg lag bij ons zeker gedurende de laatste jaren zelfs duidelijk boven het Europese gemiddelde. Ondanks de grote maatschappelijke populariteit van ons systeem van verplichte ziekteverzekering, vormt het probleem van de kostenbeheersing toch steeds één van de belangrijkste discussiepunten tijdens de regeringsonderhandelingen. Wanneer de stijging van de uitgaven niet kan worden afgeremd, zullen in de toekomst ongetwijfeld fundamentele vragen over de organisatie van het systeem naar voor worden geschoven (Schokkaert en Van de Voorde, 2003)

Wie betaalt supplementen in de Belgische gezondheidszorg?

Ondanks de genomen beschermingsmaatregelen (bv. de maximumfactuur) zijn de eigen betalingen voor gezondheidszorg van de patiënten gedurende de laatste jaren gestegen. Deze eigen betalingen bestaan uit remgelden en supplementen. In dit artikel onderzoeken we de sociale gevolgen van deze evolutie: we analyseren de omvang van de supplementen en vooral ook hun verdeling over de Belgische bevolking. De analyses gebeuren op basis van de administratieve gegevens van de terugbetalingen binnen de verplichte ziekteverzekering in 2003 voor een steekproef van 300.000 individuen. We vinden da

Connecting defects and amorphization in UiO-66 and MIL-140 metal-organic frameworks: a combined experimental and computational study.

The mechanism and products of the structural collapse of the metal-organic frameworks (MOFs) , and upon ball-milling are investigated through solid state (13)C NMR and pair distribution function (PDF) studies, finding amorphization to proceed by the breaking of a fraction of metal-ligand bonding in each case. The amorphous products contain inorganic-organic bonding motifs reminiscent of the crystalline phases. Whilst the inorganic Zr6O4(OH)4 clusters of remain intact upon structural collapse, the ZrO backbone of the frameworks undergoes substantial distortion. Density functional theory calculations have been performed to investigate defective models of and show, through comparison of calculated and experimental (13)C NMR spectra, that amorphization and defects in the materials are linked.The manuscript was written through contributions of all authors. TDB conceived the initial project. T.D.B. acknowledges Trinity Hall (University of Cambridge) and Professor Anthony K. Cheetham for use of lab facilities. D.G.R. acknowledges the UK MRC for financial support. The authors acknowledge Diamond Light Source for the provision of synchrotron access to Beamline I15 (ex p. EE9691) and Philip A. Chater and Andrew Cairns for assistance with data collection. T.K.T. and C.M.D. thank the French National Research Agency (ANR project: HOPFAME ANR-13-BS07-0002-01) and the Foundation de l'Orangerie for funding. The calculations have been performed using the HPC resources from GENCI (CINES/TGCC/IDRIS) through Grant (2015-097343 and -091461). B.B., B.V.d.V. and D.D.V . gratefully acknowledge the FWO for funding (aspirant grant).This is the final version of the article. It was first available from the Royal Society of Chemistry via http://dx.doi.org/10.1039/C5CP06798

Ferulic acid-4-O-sulfate rather than ferulic acid relaxes arteries and lowers blood pressure in mice

Consumption of foods rich in ferulic acid (FA) such as wholegrain cereals, or FA precursors such as chlorogenic acids in coffee, is inversely correlated with risk of cardiovascular disease and type 2 diabetes. As a result of digestion and phase II metabolism in the gut and liver, FA is converted predominantly into ferulic acid-4-O-sulfate (FA-sul), an abundant plasma metabolite. Although FA-sul may be the main metabolite, very little has been reported regarding its bioactivities. We have therefore compared the ex vivo vasorelaxing effect of FA and FA-sul (10−7 - 3.10−5 M) on isolated mouse arteries mounted in tissue myographs. FA-sul, but not FA, elicited a concentration-dependent vasorelaxation of saphenous and femoral arteries and aortae. The FA-sul mediated vasorelaxation was blunted by 1H- [1, 2, 4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), a soluble guanylate cyclase (sGC) inhibitor. The role of sGC was confirmed in femoral arteries isolated from sGCα1(−/−) knockout mice. Furthermore, 4-aminopyridine, a specific inhibitor of voltage-dependent potassium channels, significantly decreased FA-sul mediated effects. In anesthetized mice, intravenous injection of FA-sul decreased mean arterial pressure, whereas FA had no effect, confirming the results obtained ex vivo. FA-sul is probably one of the major metabolites accounting for the blood pressure-lowering effects associated with FA consumption

Rapid Decline of Follicular Lymphoma-Associated Chylothorax after Low Dose Radiotherapy to Retroperitoneal Lymphoma Localization

Chylothorax is caused by disruption or obstruction of the thoracic duct or its tributaries that results in the leakage of chyle into the pleural space. A number of interventions have been used to treat chylothorax including the treatment of the underlying disease. Lymphoma is found in 70% of cases with nontraumatic malignant aetiology. Although patients usually have advanced lymphoma, supradiaphragmatic disease is not always present. We discuss the case of a 63-year-old woman presenting with progressive respiratory symptoms due to chylothorax. She was diagnosed with a stage IIE retroperitoneal grade 1 follicular lymphoma extending from the coeliac trunk towards the pelvic inlet. Despite thoracocentesis and medium-chain triglycerides (MCT), diet chylothorax reoccurred. After low dose radiotherapy (2×2 Gy) to the abdominal lymphoma there was a marked decrease in lymphadenopathy at the coeliac trunk and a complete regression of the pleural fluid. In this case, radiotherapy was shown to be an effective nontoxic treatment option for lymphoma-associated chylothorax with long-term remission of pleural effusion

Risk adjustment and risk selection on the sickness fund insurance market in five European countries

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers’ preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers’ direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment—as is the case in all five countries in the year 2001—the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds

The breadth of primary care: a systematic literature review of its core dimensions

Background: Even though there is general agreement that primary care is the linchpin of effective health care delivery, to date no efforts have been made to systematically review the scientific evidence supporting this supposition. The aim of this study was to examine the breadth of primary care by identifying its core dimensions and to assess the evidence for their interrelations and their relevance to outcomes at (primary) health system level. Methods: A systematic review of the primary care literature was carried out, restricted to English language journals reporting original research or systematic reviews. Studies published between 2003 and July 2008 were searched in MEDLINE, Embase, Cochrane Library, CINAHL, King's Fund Database, IDEAS Database, and EconLit. Results: Eighty-five studies were identified. This review was able to provide insight in the complexity of primary care as a multidimensional system, by identifying ten core dimensions that constitute a primary care system. The structure of a primary care system consists of three dimensions: 1. governance; 2. economic conditions; and 3. workforce development. The primary care process is determined by four dimensions: 4. access; 5. continuity of care; 6. coordination of care; and 7. comprehensiveness of care. The outcome of a primary care system includes three dimensions: 8. quality of care; 9. efficiency care; and 10. equity in health. There is a considerable evidence base showing that primary care contributes through its dimensions to overall health system performance and health. Conclusions: A primary care system can be defined and approached as a multidimensional system contributing to overall health system performance and health

Risk adjustment and risk selection on the sickness fund insurance market in five European countries

From the mid-1990s citizens in Belgium, Germany, Israel, the Netherlands and Switzerland have a guaranteed periodic choice among risk-bearing sickness funds, who are responsible for purchasing their care or providing them with medical care. The rationale of this arrangement is to stimulate the sickness funds to improve efficiency in health care production and to respond to consumers' preferences. To achieve solidarity, all five countries have implemented a system of risk-adjusted premium subsidies (or risk equalization across risk groups), along with strict regulation of the consumers' direct premium contribution to their sickness fund. In this article we present a conceptual framework for understanding risk adjustment and comparing the systems in the five countries. We conclude that in the case of imperfect risk adjustment-as is the case in all five countries in the year 2001-the sickness funds have financial incentives for risk selection, which may threaten solidarity, efficiency, quality of care and consumer satisfaction. We expect that without substantial improvements in the risk adjustment formulae, risk selection will increase in all five countries. The issue is particularly serious in Germany and Switzerland. We strongly recommend therefore that policy makers in the five countries give top priority to the improvement of the system of risk adjustment. That would enhance solidarity, cost-control, efficiency and client satisfaction in a system of competing, risk-bearing sickness funds. [Authors]]]> Health Care Reform ; Insurance Selection Bias ; Managed Competition ; National Health Programs ; Risk Adjustment eng oai:serval.unil.ch:BIB_C1056E4EB1E1 2022-05-07T01:26:22Z openaire documents urnserval <oai_dc:dc xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:xs="http://www.w3.org/2001/XMLSchema" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/ http://www.openarchives.org/OAI/2.0/oai_dc.xsd"> https://serval.unil.ch/notice/serval:BIB_C1056E4EB1E1 Accurate Estimation of Running Temporal Parameters Using Foot-Worn Inertial Sensors info:doi:10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/doi/10.3389/fphys.2018.00610 info:eu-repo/semantics/altIdentifier/pmid/29946263 Falbriard, M. Meyer, F. Mariani, B. Millet, G.P. Aminian, K. info:eu-repo/semantics/article article 2018 Frontiers in physiology, vol. 9, pp. NA info:eu-repo/semantics/altIdentifier/pissn/1664-042X urn:issn:1664-042X <![CDATA[The aim of this study was to assess the performance of different kinematic features measured by foot-worn inertial sensors for detecting running gait temporal events (e.g., initial contact, terminal contact) in order to estimate inner-stride phases duration (e.g., contact time, flight time, swing time, step time). Forty-one healthy adults ran multiple trials on an instrumented treadmill while wearing one inertial measurement unit on the dorsum of each foot. Different algorithms for the detection of initial contact and terminal contact were proposed, evaluated and compared with a reference-threshold on the vertical ground reaction force. The minimum of the pitch angular velocity within the first and second half of a mid-swing to mid-swing cycle were identified as the most precise features for initial and terminal contact detection with an inter-trial median ± IQR precision of 2 ± 1 ms and 4 ± 2 ms respectively. Using these initial and terminal contact features, this study showed that the ground contact time, flight time, step and swing time can be estimated with an inter-trial median ± IQR bias less than 12 ± 10 ms and the a precision less than 4 ± 3 ms. Finally, this study showed that the running speed can significantly affect the biases of the estimations, suggesting that a speed-dependent correction should be applied to improve the system's accuracy