Blockchain Papers

Barbara Isensee, Reiner Hanewinkel

No abstract is available for this record.

Kai Leichsenring, Frédérique Lamontagne-Godwin, Andrea E. Schmidt, Ricardo Rodrigues · 5 authors

The emerging Austrian long-term care system in the context of a federal constitution In Austria, long-term care started to become acknowledged as a specific field of social and health policies during the 1980s, when a debate about long-term care allowances was initiated by people with disabilities acquired during their working age. The ensuing reform was marked by the legacies of the traditional Austrian welfare regime, by the federal constitution and the clear-cut distinction between the health and social care systems. The decentralized governance of health and social care in Austria has been based on two distinct principles. On the one hand, healthcare is a part of the social insurance system that is primarily regulated by the federal government, financed by contributions and administered by the self-governed health insurance agencies at federal and regional levels. The regional governments ( Bundesländer ) are involved as planners, managers and co-financers of hospitals (Hofmarcher and Quentin, 2013). On the other hand, the principle of subsidiarity has been applied to the areas of disability, social and long-term care with respective responsibilities assigned by constitutional law to the nine regional governments. Their activities are funded from general taxes that are centrally levied and distributed according to defined criteria. In practice, this means that, if patients have been assessed as being in need of long-term care, they have to rely on their own assets and/or means-tested social assistance from the local or regional authorities (Ganner, 2008).

Susanne Höhle-Pasques, Johannes Hankowitz, Peter Oberender

Against the background of increasing cost pressure in the German Health Care system German health policy introduced several law changes to increase competition within German health care system for both, payers and health care providers. At the same time law changes included centralization of decisions—counteracting a real competition. Both approaches are part of an austerity plan. The latest example for this approach is the new drug law (AMNOG) in 2011 with the core element of centralized early benefit assessment (§ 35a SGB V) for new drugs and therapies and price negotiations between federal association of health insurances and pharmaceutical company. In this review we examine the implementation of the new drug law with respect to the achievement of political objectives: Ensure sustainable financing of innovations in the German health care system, provide innovations early to the patient, decrease overregulation and establish a transparent environment in which efforts of the pharmaceutical industry are being honored by fair prices. We reviewed the new AMNOG process since its implementation on 1st January 2011 and first 64 values dossiers from pharmaceutical companies that have been evaluated by G-BA (Federal Joint Committee) between January 2011 and December 2013 with respect to the above mentioned political objectives. Parameters such as added value, determination of an adequate competitor, patient relevant endpoint surrogate parameter and subgroup analysis are being discussed. AMNOG process has been implemented as a learning system and indeed several issues have already been addressed, such as the determination of the adequate comparator by G-BA as well as the treatment of orphan drugs in this process. Basically implementation of AMNOG and early benefit assessment is a necessary step on the way to transparent priorisation of health care benefits. But the AMNOG process is one step further towards centralization of the German health care system and therefore contradicts a healthy and fair competition within the system. As a consequence the development of high quality solutions for patients might be hampered. The analysis of the first 64 value dossiers shows that less of half of the affected patient populations (40 %) have access to new therapies being reimbursed by health insurances with a premium price. There is a major inbalance in assessment of drugs in different therapeutic areas. In combination with increased uncertainty for the pharmaceutical companies the AMNOG process on the middle and long-term might jeopardize the commitment of pharmaceutical industry in the German market. This in turn endagers the political objective to ensure patients early access to innovative therapies. Besides this, centralization of the subjective parameter “added value” seems to be problematic, since value decisions should be taken by democratic processes. We therefore suggest a model in which only objectively measurable value decisions are being taken centrally and subjective value decisions are as much as possible decentralized. This results in both a stronger competition of qualitatively best solutions for patients and in a higher fault tolerance. Instruments such as health care research and conditional reimbursement can help to enhance a fair competition for more quality in regionally organized health care and more economical allocation of short resources.

Alice Ghent

year as Switzerland's Federal Office of Public Health (FOPH) announces the annual round of health insurance premium increases, this nation of 7.5 million people lets out a collective groan. Last year, the pain was greater than usual. Concerned about the depletion of cash reserves insurers' coffers, the FOPH allowed rises of up to 14.6% for basic insurance premiums depending on the canton. That hurt. Since 1999 the Swiss have seen health insurance costs rise by 50%, according to the FOPH. From 2008-2009, the price hike was significant enough to cut 0.1% from rising household disposable income. Nadia Bouchardy does not need an announcement to know that a sizeable portion of her family's income is being spent on health. Married to an ambulance driver with two young daughters, the family has an annual income of 90 000 Swiss francs (US$ 83 000) before taxes and insurances. year around 10 500 Swiss francs (US$ 9700) or 12.5% of their income goes on health insurance and extra expenses such as dental care. Last year, Bouchardy, who is aged 41, had an operation and had to pay 10% of the costs of the operation, medicine and her stay hospital. (In out-of-pocket expenses are capped to ensure families do not suffer what is termed catastrophic expenses). We are not very happy with the health insurance system Switzerland, she says. Every year we pay more and we get less. The lists with items that are not covered anymore by the health insurance gets longer. Some items like glasses or basic medicine are not fully covered, so we have to pay these costs out of our non-health budget. So far we are lucky we have not been forced to borrow money order to pay the health bill. The Bouchardy family represents how middle-income Switzerland is being squeezed financially. They earn too much to benefit from the health subsidy received by households that spend more than about 8% of their income on premiums (the level of subsidy depends on the canton). Some 40% of households receive the subsidy--either through a lower premium or tax rebate--which is the government's mechanism for preventing the cost of insurance from unfairly disadvantaging low-income families. Professor Alberto Holly, of the University of Lausanne, is an expert Switzerland's health financing system. He points to a system that is envied for its universal coverage, its equity, standard of care and lack of waiting lists. of the strengths of the Swiss system is equity with respect to health risk and patient ratio. No one is penalized for age, gender or medical history. However, it is not totally equitable and is regressive respect to income, he says. Under the Swiss constitution, the Federal Government is responsible for managing the health insurance but has limited responsibility terms of health policy. Instead, this energetically democratic country has a decentralized system which the 26 cantons are autonomous and choose how to organize their own health care. results a wide disparity terms of insurance premiums, which are usually paid by householders, not employers. [ILLUSTRATION OMITTED] Since 1996, it has been illegal not to have basic health insurance Switzerland. There are 82 not-for-profit insurers that offer policies costing around 350 Swiss francs (US$ 325) a month per adult. No one can be turned away under this scheme, known as LAMal. Further, some 44 companies offer complementary forms of insurance, which allow benefits such as dental treatment and access to luxurious hospitals, and these companies are free to choose clients according to their risk profile. One characteristic of Switzerland's health-financing system is its expense. This is not an efficient system, says Holly, in that it has not been possible to control costs. The result is that Switzerland has the third most expensive medical system the world. …

Thomas P. Weil

Since public officials in the United States may lack the courage and political will to significantly raise payroll taxes or the contain Social Security, Medicare and Medicaid benefits, Americans can anticipate that; (a) future generations increasingly will pay for these entitlements; (b) additional cutbacks to providers in Medicare, Medicaid and health maintenance organization reimbursement will hasten the current thrust of hospitals, physicians and insurers in forming huge health networks with their powerful managed care plans; and, (c) many of these new alliances will function as virtual monopolies--eventually resulting in the public proposing that state health services commissions be established. This article then suggests that future modifications in how the United States health delivery system be organized and financed preferably should be along the lines of the German multi-player, multi-tier, self-governing, decentralized, quasi-private, quasi-public model; and, also patterned after experiences of the State of Arizona's Medicaid program. It concludes that what America needs most is a hybrid of the European global budgetary targets to constrain total health expenditures, and the competitive managed care concept to curtail use patterns and to enhance quality.

J.‐Matthias Graf v. d. Schulenburg

The health care system of the Federal Republic of Germany relies on the private sector for the financing, delivery, and payment of care. However, the private sector is regulated by the government to ensure that broad societal interests are being fulfilled. The system has managed to achieve comprehensive coverage and equal access for all citizens, freedom of choice for patients, high-quality medical care, and cost containment. The reason for this success is a combination of decentralized power and decision making and the establishment of an effective negotiation system that takes place at federal, state, and local levels. The system suffers from some problems, however, which will have to be addressed: the present structuring of hospital and ambulatory care results in excessively long lengths of stay in hospital; drugs are overprescribed; the supply of health professionals does not meet the country's needs; more nursing homes are needed; and eastern Germany must be fully integrated into the system.