RESUMEN
By the end of 2018, 42 years after the landing of the two Viking seismometers on Mars, InSight will deploy onto Mars' surface the SEIS (Seismic Experiment for Internal Structure) instrument; a six-axes seismometer equipped with both a long-period three-axes Very Broad Band (VBB) instrument and a three-axes short-period (SP) instrument. These six sensors will cover a broad range of the seismic bandwidth, from 0.01 Hz to 50 Hz, with possible extension to longer periods. Data will be transmitted in the form of three continuous VBB components at 2 sample per second (sps), an estimation of the short period energy content from the SP at 1 sps and a continuous compound VBB/SP vertical axis at 10 sps. The continuous streams will be augmented by requested event data with sample rates from 20 to 100 sps. SEIS will improve upon the existing resolution of Viking's Mars seismic monitoring by a factor of â¼ 2500 at 1 Hz and â¼ 200 000 at 0.1 Hz. An additional major improvement is that, contrary to Viking, the seismometers will be deployed via a robotic arm directly onto Mars' surface and will be protected against temperature and wind by highly efficient thermal and wind shielding. Based on existing knowledge of Mars, it is reasonable to infer a moment magnitude detection threshold of M w â¼ 3 at 40 ∘ epicentral distance and a potential to detect several tens of quakes and about five impacts per year. In this paper, we first describe the science goals of the experiment and the rationale used to define its requirements. We then provide a detailed description of the hardware, from the sensors to the deployment system and associated performance, including transfer functions of the seismic sensors and temperature sensors. We conclude by describing the experiment ground segment, including data processing services, outreach and education networks and provide a description of the format to be used for future data distribution. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11214-018-0574-6) contains supplementary material, which is available to authorized users.
RESUMEN
The point of departure for this contribution is a problem common to all Western healthcare systems, namely the deficiency of their basic building block, the physician-patient relationship. This deficiency opens up a market for complementary agents in healthcare, ranging from medical associations to the central government. While Germany has traditionally put the emphasis on medical associations as the dominant complementary agent (DCA), it is shifting towards the central government. Switzerland, on the other hand, traditionally has relied on the cantonal governments and is now moving towards competing (quasi-) private health insurers that would function as DCAs. Thus, managed care, which is a means through which to reshape the physician-patient relationship, is used quite differently in the 2 countries, with differing expected outcomes and different consequences for the pharmaceutical industry.
Asunto(s)
Programas Controlados de Atención en Salud , Atención a la Salud , Alemania , Humanos , SuizaRESUMEN
Health insurers fear that increased use of medical technology in ambulatory care results in increased billings per physician. This view may overlook certain subtle links between available, appropriated technology in ambulatory practice and the propensity to hospitalize a marginal patient. In this paper, the impacts of technology on four components of total per physician treatment cost were analyzed statistically using 1976-1978 percentage changes for a sample of more than 700 Swiss physicians: number of cases treated, per case billings for ambulatory care, rate of hospitalization and cost of a hospital stay relative to ambulatory care. On net, a 10% reduction in use of laboratory work and X-ray procedures was estimated to result in about 2 and 0.4% savings, respectively. A similar reduction of direct drug sales to patients would increase total cost by 0.3%. From the vantage point of society, even the modest savings indicated probably disappear as soon as the full social cost of a hospital stay is taken into account.
Asunto(s)
Atención Ambulatoria/economía , Ciencia del Laboratorio Clínico/economía , Control de Costos/tendencias , Pruebas Diagnósticas de Rutina/economía , Prescripciones de Medicamentos/economía , Hospitalización/economía , Humanos , Seguro de Salud/economía , Modelos Teóricos , Radiografía/economíaRESUMEN
This paper takes the economist's point of view for explaining why psychotherapy seems to be a particularly difficult discipline and what could be done about it. Whereas the so-called agency relationship (i.e. a specialized agent acting on behalf of an uninformed client) can be counted upon to resolve some of the problems in somatic care, it risks to fail in psychic care because the client frequently expresses inconsistent preferences. For this reason, family members and general practitioners may serve as comparatively good agents in ambulatory care, while in the inpatient segment of psychotherapy, patient-oriented objectives tend to be thwarted. An important condition for agency relationships to perform well, however, is that the client carry a sufficient 'price tag', implying that his treatment contributes to the economic objectives of the agent in charge. The conclusion is that choice of agency relationships, even if resulting in seemingly wasteful parallel treatment, gives rise to competition between agents for patients and thus may serve as one of the best safeguards of patients' interests in psychotherapy.
Asunto(s)
Servicios Contratados/economía , Modelos Psicológicos , Participación del Paciente , Relaciones Profesional-Paciente , Psicoterapia/economía , Atención Ambulatoria , Competencia Económica , Familia/psicología , Humanos , Modelos Económicos , Objetivos Organizacionales , Defensa del Paciente , Médicos de Familia/psicología , Psicoterapia/organización & administración , Resultado del TratamientoRESUMEN
Faced with the cost explosion in the health care sector, policy-makers in most industrialized countries have been focusing on cost-sharing in health insurance as a possible solution. This is a sanction meted out to users of medical care; the alternative of creating positive incentives for non-users has not yet received nearly as much attention. This paper reports on the experiences made by German private health insurers with their plans offering rebates as well as experience-rated bonuses for no claims. It is argued that a rebate offer may be at least as attractive as conventional cost-sharing plans from the point of view of the consumer since these new options allow him to choose the time at which he is to bear the financial consequences of an illness. In the second part of the paper, predictions are derived concerning the incentives contained in the policies written by three particular insurers. Clear evidence of a decrease in demand for ambulatory medical care at the lower end of the billings distribution is found in rebate and bonus plans. The concluding section of the paper contains a discussion of the results with a view on the continuing debate about the reform of social health insurance.
Asunto(s)
Participación de la Comunidad/economía , Deducibles y Coseguros , Honorarios y Precios , Seguro de Salud/economía , Control de Costos/métodos , Alemania Occidental , Modelos Teóricos , RiesgoRESUMEN
The working hypothesis is that a cost-insurance spiral is operating in the Swiss health care system. It consists of three causal links. First, insurance coverage is one of the factors influencing the probability with which an individual sees a physician for a given condition. With improved coverage, demand for initial contacts will rise, inducing changes in ambulatory cost per case treated as well as in the propensity of hospitalization. Due to this second relationship, members of the sick funds find themselves exposed to an increased financial risk. Therefore, they tend to adjust coverage accordingly. With this third link, a feedback is established, and the cost-insurance spiral is ready to go into another round. The questions of whether such a spiral exists, the speed with which it turns, and how it could be slowed down are at the core of an investigation that will be completed in 1982. Members of a major sick fund have already been sampled in order to supplement insurance records with socioeconomic data.
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Control de Costos/tendencias , Servicios de Salud/economía , Seguro de Salud/economía , Atención Ambulatoria/economía , Humanos , Derivación y Consulta/economía , SuizaRESUMEN
This article's point of departure is that the individual has to manage three stochastic assets, namely health, wealth, and wisdom (skills), which tend to be positively correlated. It shows that the unexpected components of insurance payments should be negatively correlated for minimizing total asset volatility. The empirical finding is that in the United States, Japan, and Germany, the lines of social insurance contribute less to diversification than do those of private insurance. The article concludes with suggestions for new, umbrella-type insurance contracts that in the future should help individuals in the efficient management of their assets.
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Cobertura del Seguro/tendencias , Seguro de Salud , Sector Privado , Seguridad Social , Alemania , Cobertura del Seguro/economía , Seguro de Vida , Japón , Programas Nacionales de Salud , Estados Unidos , Indemnización para TrabajadoresRESUMEN
Policymakers fear that health insurers when exposed to competition will engage in cream-skimming (i.e. selection of good risks) rather than trying to improve their benefit to premium ratio. This fear surfaced also when Swiss federal government proposed pro-competitive Law on social health insurance, which barely passed a popular referendum in 1994. While a risk equalization mechanism based on age, gender, and place of residence has already been created, there is a considerable interest in improving its formula. This paper shows that a dummy variable indicating an individual's death during the period of observation causes the coefficient of determination to jump from 0.039 to 0.111. More-over, simulations of the risk selection process suggest that risk equalization should be made a permanent institution rather than being limited to a life of 10 years as prescribed by present legislation. In fact, the formula in use, with all its shortcomings, can be shown to neutralize to a great extent insurer interest in cream skimming provided he takes a longer-run view.
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Selección Tendenciosa de Seguro , Programas Nacionales de Salud/economía , Cobertura Universal del Seguro de Salud/economía , Análisis Actuarial , Factores de Edad , Benchmarking , Competencia Económica/legislación & jurisprudencia , Investigación sobre Servicios de Salud , Estado de Salud , Fondos de Seguro/economía , Fondos de Seguro/estadística & datos numéricos , Modelos Econométricos , Programas Nacionales de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/estadística & datos numéricos , Análisis de Regresión , Ajuste de Riesgo , Medición de Riesgo , Factores Sexuales , Suiza , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaRESUMEN
Cross-border care is likely to become a major issue among EU countries because patients have the option of obtaining treatment abroad under Community Regulations 1408/71. This paper develops a model formalizing both the patient's decision to apply for cross-border care and the authorizing physician's decision to admit a patient to the program. The patient is assumed to maximize expected utility, which depends on the quality of care and the length of waiting in the home country and the host country, respectively. Not all patients qualifying for the EU program present themselves to the authorizing physician because of the transaction cost involved. The physician in her turn shapes effective demand for authorization through her rate of refusal, which constitutes information to potential applicants about the probability of obtaining treatment abroad. The authorizing physician thus acts as an agent serving two principals, her patient and her national government, trading off the perceived utility loss of patients who are rejected against her commitment to domestic health policy. The model may be used to explain existing patient flows between EU countries.
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Control de Acceso/estadística & datos numéricos , Cooperación Internacional , Programas Nacionales de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Áreas de Influencia de Salud , Determinación de la Elegibilidad , Europa (Continente) , Unión Europea , Control de Acceso/economía , Necesidades y Demandas de Servicios de Salud , Investigación sobre Servicios de Salud/métodos , Humanos , Modelos Econométricos , Programas Nacionales de Salud/economía , Relaciones Médico-Paciente , Calidad de la Atención de Salud , Procesos Estocásticos , Viaje , Listas de EsperaRESUMEN
Grossman derives the demand for health from an optimal control model in which health capital is both a consumption and an investment good. In his approach, the individual chooses his level of health and therefore his life span. Initially an individual is endowed with a certain amount of health capital, which depreciates over time but can be replenished by investments like medical care, diet, exercise, etc. Therefore, the level of health is not treated as exogenous but depends on the amount of resources the individual allocates to the production of health. The production of health capital also depends on variables which modify the efficiency of the production process, therefore changing the shadow price of health capital. For example, more highly educated people are expected to be more efficient producers of health who thus face a lower price of health capital, an effect that should increase their quantity of health demanded. While the Grossman model provides a suitable theoretical framework for explaining the demand for health and the demand for medical services, it has not been too successful empirically. However, empirical tests up to this date have been exclusively based on cross section data, thus failing to take the dynamic nature of the Grossman model into account. By way of contrast, the present paper contains individual time series information not only on the utilization of medical services but also on income, wealth, work, and life style. The data come from two surveys carried out in 1981 and 1993 among members of a Swiss sick fund, with the linkage between the two waves provided by insurance records. In all, this comparatively rich data set holds the promise of permitting the Grossman model to be adequately tested for the first time.
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Necesidades y Demandas de Servicios de Salud/economía , Estado de Salud , Modelos Económicos , Aceptación de la Atención de Salud/estadística & datos numéricos , Depreciación , Encuestas de Atención de la Salud , Gastos en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Inversiones en Salud , Salarios y Beneficios/estadística & datos numéricos , Factores Socioeconómicos , SuizaAsunto(s)
Enfermedades Cardiovasculares/prevención & control , Adolescente , Adulto , Presión Sanguínea , Niño , Preescolar , Femenino , Humanos , Masculino , Análisis de Regresión , Riesgo , SuizaAsunto(s)
Programas Nacionales de Salud/legislación & jurisprudencia , Medicina Estatal/legislación & jurisprudencia , Sector de Atención de Salud/legislación & jurisprudencia , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Estudios de Casos Organizacionales , Medicina Estatal/economía , Medicina Estatal/organización & administración , Suecia , Suiza , Estados UnidosAsunto(s)
Seguro de Salud/economía , Programas Nacionales de Salud/economía , Sistema de Pago Simple/economía , Participación de la Comunidad/economía , Participación de la Comunidad/psicología , Participación de la Comunidad/estadística & datos numéricos , Recolección de Datos , Alemania , Costos de la Atención en Salud , Política de Salud , Investigación sobre Servicios de Salud , Humanos , Selección Tendenciosa de Seguro , Seguro de Salud/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Privatización/economía , Reembolso de IncentivoAsunto(s)
Gastos en Salud/tendencias , Recursos en Salud/provisión & distribución , Longevidad , Modelos Econométricos , Anciano , Envejecimiento , Europa (Continente) , Unión Europea , Femenino , Gastos en Salud/estadística & datos numéricos , Humanos , Esperanza de Vida , Masculino , Dinámica Poblacional , Sector Privado/economía , Sector Público/economíaAsunto(s)
Cuidadores/psicología , Financiación Personal/estadística & datos numéricos , Anciano Frágil/estadística & datos numéricos , Seguro de Cuidados a Largo Plazo/estadística & datos numéricos , Relaciones Padres-Hijo , Anciano , Altruismo , Cuidadores/economía , Cuidadores/estadística & datos numéricos , Conducta de Elección , Alemania , Atención Domiciliaria de Salud/economía , Humanos , Seguro de Cuidados a Largo Plazo/legislación & jurisprudencia , Modelos Psicológicos , Modelos Estadísticos , Motivación , Salarios y BeneficiosAsunto(s)
Cuidadores/economía , Atención Domiciliaria de Salud/economía , Cuidados a Largo Plazo/economía , Asistencia Pública/estadística & datos numéricos , Mujeres/psicología , Cuidadores/psicología , Países Desarrollados , Femenino , Alemania , Política de Salud/economía , Humanos , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Modelos Económicos , Motivación , Rol , Salarios y Beneficios/estadística & datos numéricos , Factores Sexuales , Recursos HumanosRESUMEN
The two approved combination therapies for the treatment of hepatitis C in Switzerland (Pegasys/Copegus, PAC; PegIntron/Rebetol, PIR) are very similar in terms of efficacy and safety. This study aims at comparing the cost of the two therapies and determining the cost-efficient treatment algorithm. Average cost amounts to CHF 21700.-(PAC) and CHF 19700.- (PIR) for patients with genotype 1 and to CHF 15600.- (PAC) and CHF 15000.- (PIR) for patients with genotype 2/3, respectively. The consistent use of PIR is 9 to 12% cheaper than PAC. Further cost savings of 3% are possible if patients with a bodyweight below 85 kg (genotype 1) or below 75 kg (genotype 2/3) are treated with PIR while patients with a bodyweight over 85 kg (genotype 1) or over 75 kg (genotype 2/3) are treated with PAC.
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Antivirales/administración & dosificación , Antivirales/economía , Hepatitis C/tratamiento farmacológico , Hepatitis C/economía , Interferón-alfa/administración & dosificación , Interferón-alfa/economía , Polietilenglicoles/administración & dosificación , Polietilenglicoles/economía , Ribavirina/administración & dosificación , Algoritmos , Peso Corporal , Ahorro de Costo , Quimioterapia Combinada , Genotipo , Hepatitis C/genética , Humanos , Interferón alfa-2 , Proteínas RecombinantesRESUMEN
Salas and Raftery allege that in our paper, (1) remaining life expectancy is an endogenous explanatory variable of health care expenditure and (2) the parameter designed to correct for sample selection bias in fact represents a hidden relationship between health care expenditure and age. We argue that claim (1) is not supported by the available empirical evidence, while claim (2) seems to derive from a too cursory reading of our paper.
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Gastos en Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/economía , Modelos Econométricos , Factores de Edad , Anciano , Europa (Continente) , Humanos , Esperanza de Vida , Sesgo de SelecciónRESUMEN
This paper studies the relationship between health care expenditure (HCE) and age, using longitudinal rather than cross-sectional data. The econometric analysis of HCE in the last eight quarters of life of individuals who died during the period 1983-1992 indicates that HCE depends on remaining lifetime but not on calendar age, at least beyond 65+. The positive relationship between age and HCE observed in cross-sectional data may be caused by the simple fact that at age 80, for example, there are many more individuals living in their last 2 years than at age 65. The limited impact of age on HCE suggests that population ageing may contribute much less to future growth of the health care sector than claimed by most observers.