"Steeping" Of Health Expenditure Profiles

If health care expenditure for the elderly grows faster than for younger people, the expenditure profiles become "steeper" – we call that "steeping". Three instruments for measuring "steeping" are presented: (1) trend of the relation between per-capita-expenditure of the old and the young; (2) comparing the linear slopes of per-capita-expenditure in age groups; (3) trend in parameters of non-linear modelling of expenditure profiles. Using data of the largest German private health insurer over a period of 18 years, "steeping" could be observed by all three methods in most examined insurance plans. A prognosis for 2040 shows that per-capita-expenditure will increase by 128 %. --health care expenditure,expenditure profiles,demographics

Versteilerung der alters- und geschlechtsspezifischen Ausgabenprofile von Krankenversicherern

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In vitro selection using a dual RNA library that allows primerless selection

High affinity target-binding aptamers are identified from random oligonucleotide libraries by an in vitro selection process called Systematic Evolution of Ligands by EXponential enrichment (SELEX). Since the SELEX process includes a PCR amplification step the randomized region of the oligonucleotide libraries need to be flanked by two fixed primer binding sequences. These primer binding sites are often difficult to truncate because they may be necessary to maintain the structure of the aptamer or may even be part of the target binding motif. We designed a novel type of RNA library that carries fixed sequences which constrain the oligonucleotides into a partly double-stranded structure, thereby minimizing the risk that the primer binding sequences become part of the target-binding motif. Moreover, the specific design of the library including the use of tandem RNA Polymerase promoters allows the selection of oligonucleotides without any primer binding sequences. The library was used to select aptamers to the mirror-image peptide of ghrelin. Ghrelin is a potent stimulator of growth-hormone release and food intake. After selection, the identified aptamer sequences were directly synthesized in their mirror-image configuration. The final 44 nt-Spiegelmer, named NOX-B11-3, blocks ghrelin action in a cell culture assay displaying an IC(50) of 4.5 nM at 37°C

Risk-Adjusted Capitation Payments: How Well Do Principal Inpatient Diagnosis-Based Models Work in the German Situation? Results From a Large Data Set

The Risk Adjustment Reform Act of 2001 mandates that a health-status-based risk adjustment mechanism has to be implemented in Germany's Statutory Health Insurance system by January 1, 2007. German parliament decided this as with the existing demographic risk adjustment model, that means there is cream skimming and sickness funds hesitate to engage in managing care for the chronical ill. Four approaches were used to test the feasibility of incorporating use of diagnosis as a proxy measure for health status in a German risk adjustment formula. The first two models used standard demographic and socio-demographic variables. The other two models are separately incorporating a simple binary indicator for hospitilization and Hierarchical Coexisting Conditions (HCCs: DxCG® Risk Adjustment Software Release 6.1) using inpatient diagnosis. Age and gender grouping accounted for 3.2% of the variation in total expenditures for concurrent as well as prospective models. The current German risk adjusters age, sex, and invalidity status account for 5.1% and 4.5% of the variance in the concurrent and prospective models respectively. There are substantial increases in explanatory power, however, when HCCs are added. Age, gender, invalidity status and HCC covariates explain about 37% of the variations of the total expenditures in a concurrent model and roughly 12% of the variations of total expenditures in a prospective model. For high-risk (cost) groups, substantial underprediction remains; conversely, for the low-risk group, represented by enrolees who did not show any health care expense in the base year, all of the models over-predict expenditure. --Risk Adjustment,HCCs,Germany

Umsetzung und empirische Abschätzung der Übergangsregelungen zur Einführung des Gesundheitsfonds

Das Bundesministerium für Gesundheit hat die Verfasser mit dem Gutachten zur Umsetzung und empirischen Abschätzung der Übergangsregelungen zur Einführung des Gesundheits-fonds (§ 272 SGB V) beauftragt. Die Verfasser haben am 01. April 2008 den Entwurf des Gutachtens vorgelegt. Es bestand Übereinstimmung mit dem Bundesministerium für Gesundheit, dass es für die bessere Verständlichkeit und fachliche und politische Bewertung des Gu-tachtens sinnvoll sei, verschiedene Aspekte des Gutachtens in der Endfassung noch ausführlicher darzustellen. Der Vorschlag der Gutachter hinsichtlich der Umsetzung der Übergangsre-gelung bei einer Unterfinanzierung des Gesundheitsfonds wurde gestrafft; der Vorschlag der Gutachter zur Umsetzung der Berücksichtigung der Beitragseinnahmen aus geringfügigen Beschäftigungsverhältnissen wurde gegenüber der Entwurfsfassung neu gestaltet. Auch wur-de die Abgrenzung des Gutachtensauftrags von den Anfang 2007 vorgelegten Gutachten zu den Regionalwirkungen des GKV-WSG verdeutlicht. Schließlich wurden zwei weitere Be-rechnungen zu finanziellen Aspekten durchgeführt und entsprechende Tabellen erstellt. Die Gutachter erhoffen sich, durch das nunmehr vorgelegte Gutachten einen Beitrag zur Ver-sachlichung der Diskussion leisten zu können. Essen, Feldkirchen und Mannheim, den 9. April 2008 Jürgen Wasem Florian Buchner Eberhard Wille --

Reactive Interactions between the Ionic Liquid BMP‐TFSI and a Na Surface

In order to obtain atomistic insights into the initial stages of the formation of the solid electrolyte interphase (SEI) in Na ion or Na metal batteries, we employ surface chemistry experiments and DFT calculations to study the interactions and reactions between a Na surface and the ionic liquid (IL) 1-butyl-1-methylpyrrolidinium bis(trifluoromethylsulfonyl)imide (BMP-TFSI), a candidate to be used as electrolyte in batteries. Oxygen-free Na thin films, which were grown on Ru(0001) and characterized by X-ray and ultraviolet photoelectron spectroscopy (XPS, UPS), can be understood as model of a Na-rich electrode. After deposition of submonolayer to multilayer BMP-TFSI films on the Na thin films at room temperature, XPS measurements revealed partial decomposition and the formation of a ‘contact layer’ at the Na surface, consisting of mainly TFSI-based decomposition products

Model Studies on the Formation of the Solid Electrolyte Interphase: Reaction of Li with Ultrathin Adsorbed Ionic-Liquid Films and Co3_{3}O4_{4}(111) Thin Films

In this work we aim towards the molecular understanding of the solid electrolyte interphase (SEI) formation at the electrode electrolyte interface (EEI). Herein, we investigated the interaction between the battery‐relevant ionic liquid (IL) 1‐butyl‐1‐methylpyrrolidinium bis(trifluoromethylsulfonyl)imide (BMP‐TFSI), Li and a Co$_{3}$O$_{4}$(111) thin film model anode grown on Ir(100) as a model study of the SEI formation in Li‐ion batteries (LIBs). We employed mostly X‐ray photoelectron spectroscopy (XPS) in combination with dispersion‐corrected density functional theory calculations (DFT‐D3). If the surface is pre‐covered by BMP‐TFSI species (model electrolyte), post‐deposition of Li (Li$^{+}$ ion shuttle) reveals thermodynamically favorable TFSI decomposition products such as LiCN, Li$_{2}$NSO$_{2}$CF$_{3}$, LiF, Li$_{2}$S, Li$_{2}$O$_{2}$, Li$_{2}$O, but also kinetic products like Li$_{2}$NCH$_{3}$C$_{4}$H$_{9}$ or LiNCH$_{3}$C$_{4}$H$_{9}$ of BMP. Simultaneously, Li adsorption and/or lithiation of Co$_{3}$O$_{4}$(111) to LinCo$_{3}$O$_{4}$ takes place due to insertion via step edges or defects; a partial transformation to CoO cannot be excluded. Formation of Co$^{0}$ could not be observed in the experiment indicating that surface reaction products and inserted/adsorbed Li at the step edges may inhibit or slow down further Li diffusion into the bulk. This study provides detailed insights of the SEI formation at the EEI, which might be crucial for the improvement of future batteries

Die Regionaldimension in der Gesetzlichen Krankenversicherung vor dem Hintergrund des GKV-WSG: Gutachten für das Land Baden-Württemberg

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