The self-regulatory German health care system between growing competition and state hierarchy

This article focuses on the changing role of the state in financing, providing and regulating health care services under the German health care system from 1970-2000. While a reduced role of the state can be observed in terms of financing, our analysis of service provision indicates inconsistent developments. Monetary resource flow analyses indicate a decrease in private service provision as a percentage of total health expenditure, but when analysing the development of health employment we see a growth in "private" health care personnel. The most important changes, however, have taken place in terms of regulation. Since the early 1990s, the traditionally self-regulatory German health care system has simultaneously faced growing competition and state hierarchy. -- Thema des Beitrags ist die sich ändernde Rolle des Staates in der Finanzierung, Leistungserbringung und Regulierung im deutschen Gesundheitssystem zwischen 1970 und 2000. Während sich bei der Finanzierung von Gesundheitsleistungen ein Rückzug des Staates abzeichnet, ergibt die Analyse der Leistungserbringung keinen einheitlichen Trend. Gemessen in Prozent der Gesamtausgaben für Gesundheit zeigt die Untersuchung der monetären Ressourcen eine Reduzierung der privaten Leistungserbringung, wohingegen bei der Analyse des Gesundheitspersonals ein Anstieg der privaten Leistungserbringung zu erkennen ist. Die wichtigsten Änderungen erfolgten allerdings im Bereich der Regulierung. Seit den frühen 1990er Jahren befindet sich das traditionell selbstverwaltete deutsche Gesundheitssystem zunehmend in einer Umklammerung aus staatlicher Regulierung einerseits und Wettbewerb andererseits.

Determination of characteristic turbulence length scales from large-eddy simulation of the convective planetary boundary layer

Turbulente Austauschprozesse in der atmosphärischen Grenzschicht spielen eine Schlüsselrolle beim vertikalen Impuls-, Energie- und Stofftransport in der Erdatmosphäre. In meso- und globalskaligen Atmosphärenmodellen sind turbulente Austauschprozesse jedoch subskalig und müssen unter Verwendung geeigneter Schliessungsansätze parametrisiert werden. Hierbei spielt die Spezifikation der charakteristischen Turbulenzlängenskala in Abhängigkeit vom Stabilitätszustand der Atmosphäre eine entscheidende Rolle. Gegenwärtig verwendete Ansätze, die auf der Verwendung der turbulenten Mischungslänge für neutrale Schichtung sowie dimensionsloser Stabilitätsfunktionen basieren, zeigen vor allem Defizite im oberen Bereich der konvektiven Grenzschicht sowie in der Entrainmentzone, wo starke vertikale Gradienten auftreten. In der vorliegenden Arbeit wurden hochaufgelöste dreidimensionale Grobstruktursimulationen der trockenen und feuchten Grenzschicht für ein weites Spektrum von Labilitätsbedingungen durchgeführt. Erste und zweite Momente atmosphärischer Strömungsvariablen wurden aus den simulierten hydro- und thermodynamischen Feldern berechnet und diskutiert. Die Spektraleigenschaften turbulenter Fluktuationen der Strömungsvariablen, das raumzeitliche Verhalten kohärenter Strukturen sowie charakteristische Turbulenzlängenskalen wurden abgeleitet. Eine Verifizierung der charakteristischen Turbulenzlängenskalen erfolgte durch Vergleich mit Ergebnissen früherer numerischer Simulationen, mit Turbulenzmessungen in der atmosphärischen Grenzschicht sowie mit Laborexperimenten. Mit Hilfe der nichtlinearen Datenmodellierung wurden leicht verwendbare Approximationen der charakteristischen Turbulenzlängenskalen abgeleitet und deren statistische Signifikanz diskutiert. Unter Verwendung dieser Approximationen wurde ein existierendes Parametrisierungsmodell revidiert und mit Hilfe von Grobstruktursimulationen verifiziert. Desweiteren wurde der Einfluß der turbulenten Mischungslänge auf die Prognose mesokaliger Felder untersucht. Hierzu wurde mit dem Lokal-Modell des Deutschen Wetterdienstes eine entsprechende Sensitivitätsstudie durchgeführt. Anhand von Satellitendaten und Analysedaten aus der 4D-Datenassimilation wurden die Simulationsergebnisse verifiziert

Certified Unsolvability for SAT Planning with Property Directed Reachability

While classical planning systems can usually detect if a task is unsolvable, only recent research introduced a way to verify such a claim. These methods have already been applied to a variety of explicit and symbolic search algorithms, but so far no planning technique based on SAT has been covered with them. We fill this gap by showing how property directed reachability can produce proofs while only minimally altering the framework by allowing to utilize certificates for unsolvable SAT queries within the proof. We additionally show that a variant of the algorithm that does not use SAT calls can produce proofs that fit into the existing framework without requiring any changes

Convergence of divergence of OECD health care systems

This article focuses on two major questions concerning the changing role of the state in the health care systems of OECD countries. Firstly, we ask whether major changes in the level of state involvement (in health care systems) have occurred in the past thirty years. Given the fact that three types of health care systems - which are characterized by a distinct role of the state - evolved during the golden age, we secondly discuss how this distinctiveness - or more technically: variance - has changed in the period under scrutiny. While many authors analysing health policy changes exclusively concentrate on finance and expenditure data, we simultaneously consider financing, service provi-sion, and regulation. As far as financing is concerned, we observe a small shift from the public to the pri-vate sphere with a tendency towards convergence in this dimension. Expanding Peter Flora´s `growth to limits´ theses, due to the ongoing increase of total financing and the melting off of the public share `private growth and public limits´ might be a future trend in the financing dimension of health care systems. The few data available on ser-vice provision, in contrast, show neither signs of retreat of the state nor of convergence. In the regulation dimension - which we analyse by picking major health system reforms in Germany, the United Kingdom and the United States - we see the introduction or strengthening of those coordination mechanisms (hierarchy, markets and self-regulation) which were traditionally weak in the respective type of health care system. `Gate-keeping´ and DRG models are remarkable examples to show that health policy might increasingly be oriented at `best practices´ even when the respective solutions are beyond the traditional path of reforms. Putting these findings together we find a ten-dency of convergence from distinct types towards mixed types of health care systems. - --

Subset-Saturated Cost Partitioning for Optimal Classical Planning

Cost partitioning is a method for admissibly adding multiple heuristics for state-space search. Saturated cost partitioning considers the given heuristics in sequence, assigning to each heuristic the minimum fraction of remaining costs that it needs to preserve its estimates for all states. We generalize saturated cost partitioning by allowing to preserve the heuristic values of only a subset of states and show that this often leads to stronger heuristics

Landmarks, Critical Paths and Abstractions: What\u27s the Difference Anyway?

Current heuristic estimators for classical domain-independent planning are usually based on one of four ideas: delete relaxation, abstraction, critical paths, and, most recently, landmarks. Previously, these different ideas for deriving heuristic functions were largely unconnected. In my talk, I will show that these heuristics are in fact very closely related. Moreover, I will introduce a new admissible heuristic called the landmark cut heuristic which exploits this relationship. In our experiments, the landmark cut heuristic provides better estimates than other current admissible planning heuristics, especially on large problem instances

Social inequalities, regional disparities and health inequity in North African countries

<p>Abstract</p> <p>Background</p> <p>During the last decades, North African countries have substantially improved economic, social and health conditions of their populations in average. In all countries, human development in general and life expectancy, literacy and per capita income in particular have increased. However, improvement was not equally shared between groups of different milieu, regions or level of income. Social inequalities and health inequity have persisted or even worsened. Data are generally scarce and few studies were devoted to this topic in North Africa as a region. In this paper, we carry out a comparative study on the achievements of these countries, not only in terms of human development and its components but also in terms of inequalities' reduction and health equity.</p> <p>Method</p> <p>This study is based on data available for comparison between North African countries. The main data sources are provided by reports released by the World Health Organisation (WHO), United Nations Development Programme (UNDP), United Nations Children's Fund (UNICEF), the World Bank, surveys such as Demographic Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS) and finally recent papers published on equity in different countries of the region.</p> <p>Results and discussion</p> <p>There is no doubt that education, health and human development in general have improved in North Africa during the last decades. Improvement was, however, uneven and unequally enjoyed by different socioeconomic groups. Indeed, each country included in this study shows large urban-rural disparities, discrepancies between advantaged and disadvantaged regions and cities; and unacceptable differences between rich and poor. Health inequity is particularly seen through access to health services and infant mortality.</p> <p>Conclusion</p> <p>During the last decades, North African decision makers have endeavoured to improve social and economic conditions of their populations. Globally, health, education and living standard in general have substantially improved in average. However, North African countries have still a long way to go to reduce social inequalities and health inequity at different levels: rural-urban, advantaged-marginalised regions and cities, between groups of different level of income and wealth. The challenge for the next decade is not only to improve economic, social and health conditions in average but also and mainly to reduce avoidable inequalities in parallel.</p