Economic performance and cost-effectiveness of using a DEC-salt social enterprise for eliminating the major neglected tropical disease, lymphatic filariasis.

BACKGROUND: Salt fortified with the drug, diethylcarbamazine (DEC), and introduced into a competitive market has the potential to overcome the obstacles associated with tablet-based Lymphatic Filariasis (LF) elimination programs. Questions remain, however, regarding the economic viability, production capacity, and effectiveness of this strategy as a sustainable means to bring about LF elimination in resource poor settings. METHODOLOGY AND PRINCIPAL FINDINGS: We evaluated the performance and effectiveness of a novel social enterprise-based approach developed and tested in Léogâne, Haiti, as a strategy to sustainably and cost-efficiently distribute DEC-medicated salt into a competitive market at quantities sufficient to bring about the elimination of LF. We undertook a cost-revenue analysis to evaluate the production capability and financial feasibility of the developed DEC salt social enterprise, and a modeling study centered on applying a dynamic mathematical model localized to reflect local LF transmission dynamics to evaluate the cost-effectiveness of using this intervention versus standard annual Mass Drug Administration (MDA) for eliminating LF in Léogâne. We show that the salt enterprise because of its mixed product business strategy may have already reached the production capacity for delivering sufficient quantities of edible DEC-medicated salt to bring about LF transmission in the Léogâne study setting. Due to increasing revenues obtained from the sale of DEC salt over time, expansion of its delivery in the population, and greater cumulative impact on the survival of worms leading to shorter timelines to extinction, this strategy could also represent a significantly more cost-effective option than annual DEC tablet-based MDA for accomplishing LF elimination. SIGNIFICANCE: A social enterprise approach can offer an innovative market-based strategy by which edible salt fortified with DEC could be distributed to communities both on a financially sustainable basis and at sufficient quantity to eliminate LF. Deployment of similarly fashioned intervention strategies would improve current efforts to successfully accomplish the goal of LF elimination, particularly in difficult-to-control settings.

[Social Law Entitlements and Compensations for Visually Impaired Patients in Germany, Focussed on Glaucoma]. / Sozialmedizinische und versorgungsrechtliche Aspekte des Glaukoms.

Although prevention of progression is the most important issue in the treatment of glaucoma patients, information on visual aids and social law entitlements is also helpful. In this article, the main aspects of compensation for visual impairment are outlined so that you can competently support your patients, without much effort, with helpful tips and appropriate instructions.

[The core of solidarity]. / De kern van solidariteit.

Dutch Journal of Medicine (NTVG) Lecture 2013: Organized solidarity in a welfare state is impersonal, restricted and based on enlightened self-interest. Critics of the welfare state argue that it is obsolete and we should aim for a society based on individual participation. They believe that people now prefer individualized care, that it is no longer possible to set boundaries and that too much altruism is required from those with higher incomes. In this year's NTvG lecture Margo Trappenburg contended that this criticism is unjust. Many people prefer professional care to care from the family or from volunteers and it could be possible to set boundaries again: recent developments within the medical profession are hopeful. And although the more highly educated make a greater financial contribution to the welfare state, those with a lower level of education show more, and more frequent, active solidarity. There is insufficient reason to abolish the welfare state and replace it with a society of greater individual participation.

[Social-sanitary situation in Marañón's work in the context of the fight against infectious diseases]. / La cuestión sociosanitaria en la obra de Marañón en el contexto de la lucha contra las enfermedades infecciosas.

Gregorio Marañón y Posadillo (1887-1960), played a leading role in the birth of endocrinology in Spain as is well known. However, his medical work included other important and significant fields. Thus, it was especially in the 1910s and 1920s, when Marañón dealt with the social-sanitary situation in madrid probably due to his professional attachment to the treatment of several infectious diseases and epidemic outbreaks. Actually, since 1911 onwards, he was in charge of the wards of infectious diseases in the Hospital General de Madrid where he had the opportunity of treating an important number of patients suffering from this type of pathology and, as a consequence, in the following years he published several articles in medical journals and presented in the Royal Academy of Medicine in Spain, some reports on infectious diseases and the Spanish health and social conditions at the time. This paper try to analyze this field of Marañón's social and scientific activity.

[On the development of health insurance in low-income countries: the case of African countries]. / Le développement de l'assurance maladie dans les pays à faible revenu : l'exemple des pays africains.

Health financing reforms in most low-income countries promote social and micro health insurance, in order to reduce direct spending by patients. Three phases of development can be distinguished in African countries: at first, schemes were developed only for the formal sector, then micro health insurance targeted the informal sector, and finally, health insurance was included in larger plans to reach universal coverage. The impact of health insurance is, as yet, difficult to assess. If beneficiaries have a better access to health services, the financing of health sector is not significantly improved, and there is no change in professional behaviour, in particular, in public facilities. In spite of their limits, social health insurance schemes continue to be implemented, but as a part of hybrid financing system, fitting with the abilities of low-income countries.

[Social medicine and healthcare economics. The framework for future forms of healthcare]. / Sozialmedizin und Gesundheitsökonomie : Der Bedingungsrahmen zukünftiger Versorgungsformen.

In the political debate, even in academia, the concepts of "profitability" or "efficiency" are thrown around very robustly and freely with no regard for the players themselves. Economically speaking there can be no efficiency without a definition of targets in terms of outcomes and their level of quality. If even the government's Council of Economic Experts itself finds in its assessment of hospital funding that the "reform's target parameters - improving the profitability of service provision - have developed positively", but adds that "whether this also applies to the quality of services provided or to the realisation of healthcare outcomes remains to be seen due to the lack of evidence" [21], this indicates a one-sided and problematic curtailment of the concept even by highly competent bodies. Economic control of new forms of healthcare by means of prices and fees for clearly defined services is a complex problem that has not been dealt with adequately. All pricing is based on classification models aimed at ensuring cost and benefit clusters that are as homogeneous as possible. Classification models in healthcare as a basis for price control targets need constant adjusting to ensure accuracy of mapping and appropriateness to performance. A prerequisite for the methodology behind price control models of this kind is presupposing a responsible, rule-bound and criteria-based handling of "variance" and "coincidence" by means of risk-adjusted quality and price systems. They will define the character of a wide range of steering tools and have an effect that goes beyond the narrow formal confines of the sector. That is why the regulatory framework will need first and foremost to define a qualitative framework for the political "security infrastructure" by means of deregulated economic processes in which price control becomes accountable and is justified in terms of content.

[In favour of a "new social psychiatry". Current focuses and trends of mental health care dealing between integrative and health economic perspectives]. / Für eine "Neue Sozialpsychiatrie": Aktuelle Brennpunkte und Entwicklungslinien der psychiatrischen Versorgung im Spannungsfeld von integrativen und gesundheitsökonomischen Perspektiven.

Starting from modified sociodemographical, medical, familiar and health economical circumstances it is shown that in different areas of psychiatric supply fundamental offerings are missing or need to be established, thus one has to speak about an undersupply of certain groups (migrants, personality disorders, certain elderly patients). Some of these forward-looking trends and possible prospects in the field of social psychiatry are exemplarily displayed. The thesis is argued and illustrated that the existing social psychiatric institutions require a paradigmatic reorientation, which could be called "New Social psychiatry" and should complement the traditional social psychiatry, which has been orientated to schizophrenic illness, extramural alignment and the rehabilitation purpose of employment up to now.

[Classification of social medical products provided by the German Medical Services of the Statutory Health Insurance in Hessen]. / Zur Klassifikation sozialmedizinischer Leistungen des Medizinischen Dienstes der Krankenversicherung in Hessen nach Produktgruppen1.

Based on agreements presented by a task force the German Medical Services of the Statutory Health Insurance in Hessen developed its own classification of social medical assignments. According to economic systematics they were arranged in groups of external and internal products reflecting providing services in form of medical expertises and fulfilment of legal obligations. Further typologisation of the products can be achieved by relational marks. Documentation based on this classification as a part of social medical controlling supports modern planning and management concepts. This way practical sociomedicine as an applied health science makes its contribution to economic efficiency of the statutory health care system.

[Observations on social medicine in public health transition]. / Sozialmedizinische Uberlegungen zum Gesundheitswesen im Wandel.

In spite of the growing criticism of the social welfare principles, the social health insurance model is remarkably stable in Europe. Key features of this model are even implemented in more market oriented models (as in Switzerland) and in national health systems as in the United Kingdom. In Germany, however, the discussion is almost solely centred around the argument of globalisation of capital and labour and, subsequently, the high additional costs on labour. This endangers social security which is financed through wages. If the social welfare system in Germany would be abolished de facto and not intelligently adapted, this would be a dramatic signal against social principles all over Europe. Consequences for social medicine as a scientific discipline are: Social medicine as a public health discipline with the goal of equality in health care must get involved in health politics. Social medicine as an empirical science has to evaluate- and refute, if necessary-existing myths and prejudices. Social medicine needs a stable network for research, teaching and practice-this is the growing field of "public health".