Five types of OECD healthcare systems: Empirical results of a deductive classification

This article classifies 30 OECD healthcare systems according to a deductively generated typology by Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system: regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by financing and finally service provision, where the superior dimension restricts the nature of the subordinate dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our argument, we classify 30 OECD healthcare systems, mainly using O…

Comparative assessment of docetaxel for safety and efficacy between hormone-sensitive and castration-resistant metastatic prostate cancer.

To compare toxicity and response of docetaxel chemotherapy between metastatic hormone-sensitive prostate cancer (mHSPC) and castration-resistant metastatic prostate cancer (mCRPC) patients of the same therapeutic era for assessing of upfront docetaxel against the benchmark of docetaxel in the castrate resistant stage in the setting outside of clinical trials.A prospectively collected database of real-world prostate cancer patients receiving docetaxel was divided in mHSPC and mCRPC cases and retrospectively analyzed. Principal objectives were toxicity measured by the common criteria of adverse events terminology and response characterized by Prostate specific antigen decline and radiographic…

ADF Winter School-An exciting concept of the Arbeitsgemeinschaft Dermatologische Forschung to connect young scientists and clinician scientists in Dermatology at the top of Germany

Prävention im Alter durch Risikovermeidung, Früherkennung und frühe Behandlung

Der wichtigste Risikofaktor fur Brustkrebs ist bei Frauen und Mannern das Alter. Brustkrebs beim Mann ist selten; Untersuchungen zur Fruherkennung werden deshalb nicht empfohlen; diese sind nur bei Veranderungen oder Beschwerden erforderlich (S3-Leitlinie Diagnostik 2018). Fur Frauen liegt das Lebenszeitrisiko fur Brustkrebs bei 12,8 %, d. h. dass jede achte Frau im Verlauf ihres Lebens an Brustkrebs erkrankt. Selten tritt Brustkrebs bei Frauen unter 30 Jahren auf. Der groste Teil der Frauen erkrankt zwischen dem 50. und 70. Lebensjahr; Mitte 60 ist das Risiko am hochsten. Etwa 37 % erkranken nach dem 70. Lebensjahr; Brustkrebs kann jedoch noch bis ins hohe Alter von 90 Jahren und mehr auft…

The timing of initial imaging in testicular cancer: impact on radiological findings and clinical decision making

Background In testicular cancer determination of clinical stage and recommendation of therapeutic strategy after inguinal orchiectomy are based on primary imaging by CT-scan of the chest and CT- or MRI- abdomen. It has not been investigated so far, whether the imaging should be performed before or after primary testicular surgery. Staging before surgery means exposing all patients to CT radiation irrespective of ensured histologic malignancy while postoperative staging could pose a risk in biased clinical decision making by increased presence of unspecific lymph node enlargement caused by postsurgical effects. Therefore, we aimed to investigate the association between the timing of initial …

Delegation and Institutional Design in Health-Care Rationing

The delegation of decision-making powers to nonmajoritarian, independent agencies has become a significant phenomenon in more and more policy areas. One of these is the health-care sector, where decisions on the range of services covered within public systems have, in most developed countries, been delegated to specialized bodies. This article offers an analytical framework that seeks to grasp the empirical variety and complexity of delegative processes and appointed institutions. The framework is used to describe decision-making processes and institutions in six countries: Austria, Germany, Norway, Sweden, New Zealand, and the United Kingdom. We find that, although constrained by preexisti…

Die Umsetzung des Präventionsgesetzes auf Länderebene: Eine Analyse der Landesrahmenvereinbarungen

Zusammenfassung Hintergrund 2015 wurde in Deutschland erstmals ein Präventionsgesetz verabschiedet. Zur Umsetzung auf Länderebene werden Landesrahmenvereinbarungen (LRVen) zwischen den Sozialversicherungsträgern und den zuständigen Landesministerien getroffen. Ziel der Arbeit Der Beitrag gibt einen Überblick über die 15 bislang abgeschlossenen LRVen und arbeitet Unterschiede und Gemeinsamkeiten zwischen den Ländern heraus. Methode Die LRVen wurden einer qualitativen Inhaltsanalyse unterzogen. Hierfür wurden zunächst für jeden Paragraphen Abweichungen von der von den Sozialversicherungsträgern auf Bundesebene konsentierten Mustervorlage festgestellt. In einem zweiten Schritt wurden die Abwei…

The Europeanization of Health Care Coverage Decisions: EU-Regulation, Policy Learning and Cooperation in Decision-Making

The paper presents two cases of Europeanization in health policy – an area that has so far been viewed as hardly affected by European integration. We show that even in the less likely case of coverage decision-making, some traces of Europeanization can be found. This is possible because the Commission has a strong interest in further integration in this field and all other relevant actors have motives to at least engage in cooperation. Our first case deals with the EU’s transparency directive and shows that this has forced member states to establish formal decision-making procedures, but did not result in a harmonization of decision-making processes and institutions, which is why the Commis…

What explains ‘generosity’ in the public financing of high-tech drugs? An empirical investigation of 25 OECD countries and 11 controversial drugs

In times of increasing cost pressures, public healthcare systems in Organisation for Economic Co-operation and Development (OECD) countries face the question of whether and to which extent new high-tech drugs are to be financed within their public healthcare systems. Systematic empirical research that explains across-country variation in these decisions is, however, almost non-existent. We analyse an original dataset that contains coverage decisions for 11 controversial drugs in 25 OECD countries using multilevel modelling. Our results indicate that the ‘generosity’ with which controversial new drugs are publicly financed is unrelated to a country’s wealth and general expenditure levels fo…