Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

<p>Abstract</p> <p>Background</p> <p>Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation') whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated.</p> <p>Methods</p> <p>Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance.</p> <p>Results</p> <p>The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care, gynecology, pediatrics and for psychiatrists whereas "prescription only" areas had lowest cost for specialists with non-invasive and invasive activities.</p> <p>Conclusions</p> <p>The results indicate that payment methods for services and for prescription drugs are associated with variations in treatment cost that are unlikely warranted by different medical needs of patients alone. Promoting physician accountability of care by linking reimbursements to quality, not quantity, of services are important policy measures to be considered for health care in Switzerland.</p

Energy Embodiment in Brazilian Agriculture: An Overview of 23 Crops

The amount of energy required to produce a commodity or to supply a service varies from one production system to another and consequently giving rise to differing levels of environmental efficiency. Moreover, since energy prices have been continuously increasing over time, this energy amount may be a factor that has economic worth. Biomass production has a variety of end-products such as food, energy, and fiber; thus, taking into account the similarity in end-product of different crops (e.g.: sunflower, peanuts, or soybean for oil) it is possible to evaluate which crops require less energy per functional unit, such as starch, oil, and protein. This information can be used in decision-making about policies for food safety or bioenergy. In this study, 23 crops were evaluated allowing for a comparison in terms of energy embodied per functional unit. Crops were grouped as follows: starch, oil, horticultural, perennial and fiber, to provide for a deeper analysis of alternatives for the groups, and subsidize further studies comparing conventional and alternative production systems such as organic or genetically modified organisms, in terms of energy. The best energy balance observed was whole sugarcane (juice, bagasse and straw) with a surplus of 268 GJ ha−1 yr−1; palm shows the highest energy return on investment with a ratio of approximately 30:1. For carbohydrates and protein production, cassava and soybean, respectively, emerged as the crops offering the greatest energy savings in the production of these functional foods

Resposta fisiológica de ovinos da raça Santa Inês alimentados com diferentes níveis de farelo de manga em substituição ao milho.

O experimento foi delineado para avaliar o efeito da substituição do milho por farelo de manga e medir os efeitos das condições climáticas ao longo do dia sobre os parâmetros fisiológicos: temperatura retal (TR), temperatura Superficial (TS) e freqüência respiratória (FR), em ovinos da raça Santa Inês, criados em confinamento em clima semi-árido. Ovinos machos castrados (n = 16) foram submetidos a quatro dietas com diferentes níveis de substituição do milho por farelo de manga. A TR, TS e FR foram medidas a cada hora durante dois períodos de 24 horas. Adotou-se o delineamento de blocos casualizados, com quatro repetições, em esquema fatorial 4 x 12 (níveis de inclusão de farelo de manga x horários de avaliação dos parâmetros fisiológicos). Não foi observado influência da dieta na TR, TS e FR dos ovinos, entretanto observou-se a influência das condições climáticas

Influence of MAX-Phase Deformability on Coating Formation by Cold Spraying

As solid-state deposition technique avoiding oxidation, cold gas spraying is capable of retaining feedstock material properties in the coatings, but typically fails to build up coatings of brittle materials. Ceramic MAX phases show partial deformability in particular lattice directions and may thus successfully deposit in cold spraying. However, deformation mechanisms under high strain rate, as necessary for cohesion and adhesion, are not fully clear yet. A MAX-phase deposit only builds up, if the specific mechanical properties of the MAX phase allow for, and if suitable spray parameter sets get realized. To investigate the influence of material properties and deposition conditions on coating microstructure and quality, three MAX phases, Ti3SiC2, Ti2AlC and Cr2AlC, were selected. Up to ten passes under different spray parameters yielded Ti2AlC and Cr2AlC coatings with thicknesses of about 200-500&nbsp;\ub5m. In contrast, Ti3SiC2 only forms a monolayer, exhibiting brittle laminar failure of the impacting particles. In all cases, the crystallographic structure of the MAX-phase powders was retained in the coatings. Thicker coatings show rather low porosities (&lt; 2%), but some laminar cracks. The deposition behavior is correlated with individual mechanical properties of the different MAX-phase compositions and is discussed regarding the particular, highly anisotropic deformation mechanisms

In vitro characterization of physico-chemical properties, cytotoxicity, bioactivity of urea-crosslinked hyaluronic acid and sodium ascorbyl phosphate nasal powder formulation

An innovative lyophilized dry powder formulation consisting of urea-crosslinked hyaluronic acid (HA-CL) and sodium ascorbyl phosphate (SAP) – LYO HA-CL – SAP- was prepared and characterized in vitro for physico-chemical and biological properties. The aim was to understand if LYO HA-CL – SAP could be used as adjuvant treatment for nasal inflammatory diseases. LYO HA-CL – SAP was suitable for nasal delivery and showed to be not toxic on human nasal septum carcinoma-derived cells (RPMI 2650 cells) at the investigated concentrations. It displayed porous, polygonal particles with unimodal, narrow size distribution, mean geometric diameter of 328.3 ± 27.5 µm, that is appropriate for nasal deposition with no respirable fraction and 88.7% of particles with aerodynamic diameter &gt;14.1 µm. Additionally, the formulation showed wound healing ability on RPMI 2650 cells, and reduced interleukin-8 (IL-8) level in primary nasal epithelial cells pre-induced with lipopolysaccharide (LPS). Transport study across RPMI 2650 cells showed that HA-CL could act not only as carrier for SAP and active ingredient itself, but potentially also as mucoadhesive agent. In conclusion, these results suggest that HA-CL and SAP had anti-inflammatory activity and acted in combination to accelerate wound healing. Therefore, LYO HA-CL – SAP could be a potential adjuvant in nasal anti-inflammatory formulations