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PubMed1999

Public and private responsibilities: home- and community-based services in the United Kingdom and Germany.

In the late 1980s, the United States, the United Kingdom, and Germany had roughly the same system of financing and delivering long-term care. In contrast to the United States, the United Kingdom and Germany enacted radical reform. The United Kingdom converted an open-ended, means-tested national entitlement for institutional care to a block grant to local governments, whereas Germany enacted a nationally uniform, non-means-tested social insurance program. This article analyzes the postreform experience of the United Kingdom and Germany with respect to issues of financing, assessment and case management, and the availability of home- and community-based services. Policy implications for the United States are developed.

Case Management↗
PubMed2001

Increasing prevalence of bronchial hyperresponsiveness in three selected areas in East Germany. Bitterfeld Study Group.

The prevalence of asthma, bronchial hyperresponsiveness (BHR) and allergic rhinitis in children was lower in East Germany compared to West Germany. The reasons for this difference are still not understood. This study tested the hypothesis that prevalence of BHR increased in East German children after reunification. Two consecutive cross-sectional surveys of schoolchildren aged 8-14 yrs from three communities in East Germany were carried out in 1992-1993 and 1995-1996. A subsample of 530 and 790 children with complete lung function and cold air challenge data was analysed. The prevalence of BHR increased from 6.4%, in 1992-1993 to 11.6% in 1995-1996 (odds ratio (OR): 2.0, 95% confidence interval (CI): 1.3-3.0, adjusted for age, sex, season, community and parental education). No changes were found for asthma, allergic rhinitis or allergic sensitization. In contrast, physician diagnosed bronchitis, pneumonia and frequent colds decreased significantly. The observed increase in the prevalence of BHR was reduced (OR: 1.5, 95% CI: 0.95-2.3) after adjustment for several indoor factors. In conclusion, while the prevalence of nonallergic respiratory diseases seems to decrease, the prevalence of bronchial hyperresponsiveness might be a first indicator of the suspected increase of asthma prevalence in East Germany. The present results give indirect evidence, that less respiratory infections may be associated with higher bronchial hyperresponsiveness.

Asthma↗
PubMed2002

Sexually transmitted diseases in Germany.

In the former West Germany, in specific venereal diseases legislation passed in 1953, only syphilis, gonorrhoea, ulcus molle, and lymphogranuloma venereum were defined as venereal diseases and subject to mandatory notification. The proportion of unreported cases was as high as 75% for syphilis and up to 90% for gonorrhoea. Epidemiological data for the past 10 years exist only on selected populations from research studies and are summarized in this article. In the former East Germany reporting of sexually transmitted infections (STIs) was mandatory and, due to the centralized organization, underreporting was considered to be low, although no specific studies have examined this. After the unification in 1990 of the two German states the West German laws were adopted in East Germany. Since 1982 - when the first AIDS case was reported in Germany - information on AIDS cases has voluntarily been collected at the national register at the AIDS Centre of the Robert Koch Institute in Berlin. The law governing the reporting of infectious diseases has recently been revised. Under the new Protection against Infection Act, which became effective on 1 January 2001, clinical diagnoses of STIs (with the exception of hepatitis B) are no longer notifiable diseases. Laboratory reporting of positive test results for Treponema pallidum has been introduced. With T. pallidum and HIV notifications, additional disaggregated data are collected. Since T. pallidum and HIV remain the only notifiable STIs, all other STIs have to be monitored through sentinel surveillance systems. These surveillance systems are currently being established. Under the new legislation, local health authorities have to provide adequate counselling and testing services for STIs, which may be provided free of charge if necessary.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Cost-effective bariatric surgery in Germany today.

BACKGROUND: The reason for this inquiry was to assess the actual state of Bariatric Surgery in Germany, especially relating to the much discussed economic aspect. METHOD: A questionnaire was sent to those hospitals in Germany in which we knew that obesity surgery was performed, concerning the year 1997. RESULTS: To our regret, the feedback was only 37%, although this must be considered an adequate response for Germany. Nevertheless, some interesting trends are easily seen. CONCLUSION: Bariatric Surgery in Germany could pay for itself by saving the costs associated with conservative therapy and preventing co-morbidities in patients with morbid obesity.

Biliopancreatic Diversion↗
PubMed1998

Economic evaluation of multiple sclerosis in the UK, Germany and France.

A cross-sectional cost-of-care study was performed to assess the economic burden of multiple sclerosis (MS) in France, Germany and the UK. Patients were stratified into 3 groups according to the Expanded Disability Severity Scale (EDSS): stages I, II and III, corresponding to mild (EDSS 1.0 to 3.5), moderate (EDSS 4.0 to 6.0) and severe (EDSS 6.5 to 8.0) MS, respectively. 90 patients with MS and 30 non-MS control patients were recruited in each country. Control patients were matched to the patients with MS on the basis of age and gender. Demographic, clinical and economic data during the 3-month period prior to entry were collected in patient interviews. Total costs included actual expenditures, such as direct medical and non-medical costs, as well as indirect costs. From the societal perspective, the total cost of MS for 3 months was estimated at 1,928 US dollars, 3,941 US dollars and 5,678 US dollars in France, 2,772 US dollars, 2,056 dollars and 5701dollars in Germany, and 5,125 US dollars, 6,751 US dollars and 14, 622 US dollars in the UK, for stage I, II and III patients, respectively. The major medical cost driver in the UK was outpatient consultations, whereas hospitalisations were the major component in Germany and France. The major cost in the UK arose from the dependence of patients with MS on caregivers, which caused high non-medical, societal costs compared with France and Germany. From both the societal and health insurance perspectives in each country, costs for control patients were lower than those for stage I MS patients. MS represents a major financial burden on the individual, the family, health services and society, and these costs increase with MS progression.

Adult↗
PubMed2005

Modelling cost effectiveness and cost utility of sequential DMARD therapy including leflunomide in rheumatoid arthritis in Germany: I. Selected DMARDs and patient-related costs.

OBJECTIVE: To quantify direct costs of medication and cost of illness (according to functional capacity) for patients with rheumatoid arthritis (RA) in Germany, allowing further use in a health economic evaluation of sequential therapy with disease-modifying antirheumatic drugs (DMARDs) in specialised, i.e. rheumatological, care in Germany. DESIGN AND SETTING: The analysis was conducted from the societal perspective in Germany using a modelling approach, which was based on secondary analysis of existing data and on data from a sample of 583 patients from the German rheumatological database of 1998. Functional capacity was defined by the Hannover Functional Ability Questionnaire (HFAQ) scores. Costs were calculated from resources utilised and patients' work capacity. Direct costs consisted of outpatient medical services, inpatient treatment, long-term care and rehabilitation treatment. Indirect costs incurred by sick leave and premature retirement were quantified according to the human-capital approach. MAIN OUTCOME MEASURES AND RESULTS: Average total direct costs (year 1998-2001 values) per patient per year for continuous treatment with the selected DMARDs comprising costs for drugs, monitoring and treatment of adverse drug reactions (ADRs) were highest for intramuscular gold (sodium aurothiomalate) [euro 2106 (euro 1 approximately equal to $US 0.91; average of the period from 2000 through 2001)] followed by leflunomide (euro 2010), azathioprine (euro 1878), sulfasalazine (euro 1190), oral methotrexate (euro 708), and lowest for the antimalarials chloroquine/hydroxychloroquine (euro 684). There were additional yearly costs for RA-related non-DMARD medication of euro 554 per patient, including management of ADRs. Mean cost of illness (year 1998 values) excluding medication cost amounted to euro 17,868 per RA patient per year. Annual costs increased with increasing disability, i.e. decreasing functional capacity, of RA patients from euro 6029 per patient with more than 94% of functional capacity to euro 28,509 per patient with <20% of functional capacity. In general, there was a predominance of indirect costs in each of the categories of functional capacity, ranging between 74% and 87% of total (direct and indirect) annual costs per RA patient. Annual direct costs increased from euro 811 to euro 7438 per patient with increasing disability. Inpatient treatment was the predominant component of direct costs. Patients in the worst category (<20%) of function experienced hospital costs that were 6.5 times higher than those of patients in the best category (>94%). CONCLUSIONS: On the basis of the data presented it can be concluded that the results of this investigation are typical for patients in rheumatological care in Germany and can therefore be used in a health economic analysis of different DMARD sequences aimed at changing disease progression over time.

Antirheumatic Agents↗
PubMed2005

Degree and content of negative meaning in four different age groups in Germany.

The aim of this study was to investigate the degree and content of negative meaning (i.e., negative evaluations, motivations, feelings) in four different age groups of men and women in East- and West-Germany. A sample was drawn from 290 cities in Germany which was stratified according to four age groups (18-25, 40-54, 55-69, and 70-85), gender and region of residence (West- or East-Germany). A total of 3,306 individuals participated in the study. A sentence completion task was administered to study negative meaning. An analysis of variance was carried out for the degree of negative meaning, as well as binary logistic regression and correspondence analysis for the content of negative meaning to study the differences between the four age groups, gender, and East- and West-Germans. The results showed that the youngest age group, men, and people living in the Western part of Germany reported significantly less negative meaning than other groups. However, the difference between the groups was very small. The negative meaning showed different content in age groups reflecting age-graded developmental tasks. Some gender and regional differences in the content of negative meaning were also found.

Adolescent↗
PubMedDate not supplied

[Fatal child abuse (caused by physical violence) in Germany during 1 January 1985 to 2 October 1990. Results of a multicenter study].

UNLABELLED: No reliable data are available on cases of lethal child abuse (by active force) in the area of Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 58 cases of lethal child abuse. Extrapolated to all institutes of legal medicine, this corresponds to 62 cases in all of West Germany in the period studied. An approximately equal number of unreported cases should be added to this figure. Including unreported cases, at least 20 cases of lethal child abuse occurred per year; thus only one in every two cases ever came to light. Almost two thirds of the victims were younger than one year old. At autopsy 59% exhibited signs of repeated abuse at autopsy. By far the most common cause of death was direct impact from a blunt object, usually to the head. Mostly, the male person to whom the victim relates most closely (father, stepfather, partner of the mother) has killed the child. Twenty-one of the 74 persons charged saw the charges against them dropped or were acquitted due to lack of evidence; 51 received sentences ranging from one year probation to life. In the remaining two cases the outcome of the trial was unknown. Signs of abuse were readily apparent at autopsy in almost all cases. The high number of unreported cases underscores the need to educate medical students and practicing physicians to be on the look-out for signs of abuse and argues for an increase in the rate of autopsy.

Autopsy↗
PubMedDate not supplied

[Fatal child neglect in West Germany 1 January 1985 to 2 October 1990. Results of a multicenter study].

UNLABELLED: Up to now reliable data were available on cases of lethal child neglect in the area of the Federal Republic of Germany prior to reunification (the former West Germany). In a multicenter study we therefore examined the police and court records for such cases occurring in the period from 1 January 1985 to 2 October 1990 in nearly the entire area of Federal Republic of Germany. RESULTS: The study center received information on 19 cases of lethal child neglect. Extrapolated to all institutes of legal medicine, this corresponds to 20 cases and thus 3.5 cases a year in the whole of West Germany in the period studied. There is to be added a dark-field which cannot be limited more precisely. However, the cases of fatal child neglect might have occurred much more seldom than fatal child abuse caused by use of physical violence. Slightly more than half the victims were younger than 1 year, the oldest one was 7 10/12 years old. Most frequently the children died of starvation and thirst. Mostly the mothers/nursing mothers killed the child alone or together with the victim's father/stepfather. In the majority of the cases there was not a close affection between parents and child. Nearly 30% female/male perpetrators suffered from chronic alcohol abuse. Only 15 (= 56%) of 27 female/male perpetrators were sentenced to imprisonment (period between 7 months on probation and 10 years). Mitigation circumstances existed for nearly half the persons sentenced to imprisonment. It is true that child neglect is a rarer crime, but the experts of legal medicine always have to indicate errors made during the external inspection of the corpse (among others failures to see indications of neglect).

Cause of Death↗
PubMed1999

[Incidence of myocardial infarct in Germany: prevalence, incidence trends, East-West comparison].

The German National Health Interview and Examination Survey, as a descriptive cross-sectional study, allows the recording of post-myocardial infarct cases, e.g. the number (prevalence) of survivors after an infarct has occurred (non-lethal myocardial infarcts). The 18 to 79 year old residential population in Germany had a lifetime prevalence of 2.45% for conditions after a heart attack. The age-specific lifetime prevalence values increase with increasing age for both men and women. Between the ages of 30 and 59 there are more than 4 male heart attack victims for every woman; between the ages of 60 and 79 this relation is only 1 to 1.5. The 30-< 80 year old population in Germany has around 1,450,000 post-myocardial infarct cases (heart attack victims). There are about 100,000 male post-myocardial infarct cases among relatively young adults between 30 and 49 years of age. There were hardly any cases in the female population in this age group. In regard to post-myocardial infarcts there were no significant morbidity differences between the eastern and western German states in 1997/98. A comparison of the lifetime prevalence rates between 1997/98 and 1990/92 shows the following trend: the number of post-myocardial infarcts in the German population 25-< 70 years old decreased; in Western Germany the lifetime prevalence rates also declined, in Eastern Germany the prevalence rates among both men and women increased in this period of time. In the period 1997/98 there were around 190,000 non-lethal myocardial infarcts in the 18 to 79 year old German population in a full 12 month period (incidence cases of survivors after the occurrence of an acute first and/or acute reinfarcts).

Adolescent↗
PubMed1999

[Prevalence of hay fever in Germany--East-West comparison and temporal trends].

In recent years several studies in children and adults have shown an increase in prevalence of atopic diseases in East and West Germany. The observed frequency of allergic diseases, however, was significantly lower in the East compared to the West. Using data of the German National Health Interview and Examination Survey 1998 and of National Surveys from 1990/92 it was examined, whether the reported increase in prevalence could be confirmed for the total population and whether the differences between East and West are still present. In a self-administered questionnaire, study participants were asked whether they have ever had hay fever. Additionally, in a physician's interview, subjects were asked whether a physician had ever diagnosed hay fever. The questionnaire data were used in comparison with the previous national surveys for the calculation of time trends. A total of 6974 persons filled in the questionnaire and 7099 persons took part in the interview. Physician-diagnosed hay fever was reported by 15% of the total study population. Clear differences in the prevalence rates between East and West Germany are still existing; 11% in the East and 17% in the West suffer from hay fever. In both parts of the country prevalence decreases with increasing age. The highest rates were found among those aged 20-29 and 30-39 years. Based on the questionnaire data the morbidity rose from about 10% in 1990/92 to 17% in 1998. The overall relative increase is quite comparable in East and West Germany. Stratification by age and gender shows considerable differences. In young women from East Germany the increase in prevalence is substantially higher and in women aged 40 years or older much lower than in West German women. In men this pattern has not been observed.

Adolescent↗
PubMed1999

[Smoking behavior in Germany].

In a representative sample, 7,124 men and women in the age of 18 to 79 years were interviewed regarding their smoking habits. In 1998, one third of the participants, 37% of the men and 28% of the women, were smokers. The highest proportion of smokers was found in the youngest age group of 18 to 24 years--49% males and 44% females. The mean cigarette consumption of male smokers was 20 cigarettes per day, that for female smokers was 16. About one third of the smokers have tried to stop smoking at least once during the past year. 86% of the men and 80% of the women started their habit under the age of 20. Compared to a previous survey in 1990/92, the proportion of male smokers dropped by 3% in West Germany, whereas in East Germany the figure remained the same. The proportion of female smokers rose by 1% in West Germany and by 8% in East Germany (from 21% to 29%). The latter change means an increase of the smoking prevalence by 42% in East German women during the short period of only 7 years.

Adolescent↗
PubMed2000

[Utilization of multimodal therapy concepts in stomach carcinoma in Germany].

INTRODUCTION: In view of disappointing results after surgery alone multimodal therapeutic regimes are used to improve long-term prognosis in locally advanced gastric carcinomas. In presence of many reports about encouraging results ("down staging", improved R0-resection rates) but simultaneously missing evidence of efficiency of neoadjuvant therapies in respect to long-term survival (large randomized multicenter trials do not exist until today) and the herewith related uncertainties, we started an inquiry among many surgical units with the intention to evaluate the clinical practice of multimodal treatment for gastric cancer patients in Germany today. METHODS: In a questionnaire (3/99) we asked among 97 surgical units (41 university hospitals, 56 big community hospitals) in Germany for the management of gastric cancer patients with special interest to practice and state of adjuvant and neoadjuvant therapeutic strategies. Further we analyzed all resected gastric cancer patients (1986-1995) without neoadjuvant treatment in advanced stage of disease (pT3/4NxMx; stage III/IV (UICC'92) in respect to R0-resection rate and long-term prognosis (Kaplan-Meier). RESULTS: Overall feedback amounted to 78% (76/97) and was higher in university hospitals (90%) than in big community hospitals (70%). Today, neoadjuvant therapies are of more interest than adjuvant therapeutic regimes. But also neoadjuvant therapy is only used in 32% as a rule (in 16% with, in 16% without study conditions). 25% of all surgical units do not employ any neoadjuvant therapy in locally advanced gastric cancer until today. In all other surgical units neoadjuvant treatment is performed more individually and sporadically (43%) only in some patients. Neoadjuvant therapies are practiced by haematooncologists in 50%, gastroenterologists in 32% and surgeons in 27%. The predominant neoadjuvant therapeutic strategy is chemotherapy alone (84%). Many surgical units in Germany are interested to participate in a multicenter trial with more interest in neoadjuvant than adjuvant therapy. 185 of 309 resected gastric cancer patients (60%) were classified as stage IIIa, stage IIIb or stage IV patients. R0-resection rate of these advanced gastric cancer patients amounted to 37%; only 24% of them survived 5 years or more. CONCLUSIONS: Considering the missing evidence that multimodal therapies are able to prolong long-term survival in advanced gastric cancer patients, its use without study conditions is questionable. Conclusions, taken from data of clinical trials regarding carcinomas of the esophagus and esophagealgastric junction, are inconsistent in respect to long-term prognosis and results are not transferable to gastric carcinomas. A prospective randomized multicenter trial in advanced gastric cancer patients is of great importance. Following our data, in Germany a high readiness to participate in the forthcoming EORTC-study is present.

Chemotherapy, Adjuvant↗
PubMed2000

[Guidelines Clearing House Statement "Hypertension". Summary and recommendations for a rational hypertension guideline in Germany].

BACKGROUND: In order to promote quality of hypertension management in Germany, a national hypertension guidelines clearing project was initiated in 1999 by the German Guidelines Clearinghouse. OBJECTIVES: To identify and review published German- and English language hypertension guidelines. To establish criteria for future guideline development and implementation. To familiarize stakeholders in Germany with state-of-the-art hypertension guidelines. To identify key topics for a future national evidence-based guideline. METHODS: Search procedure, formal appraisal: Systematic search using literature databases and English-/German-language databases, published between 1990 and 1999. Abstract screening of the search results according to the inclusion criteria (n = 132 of a total of 548 hits). Systematic guideline evaluation using checklist with predefined criteria. APPRAISAL OF GUIDELINES' CONTENTS: Peer review of guidelines with the following inclusion criteria: hypertension--general, German and English language, published later than 1994, original or primary guideline or update, issued for nationwide use. Peer review was performed by a multidisciplinary focus group of EBM experts (primary and secondary care physicians, clinical pharmacologist, clinical epidemiologist). None of these was involved in hypertension guideline development during the review period. DOCUMENTATION OF CRITICAL APPRAISAL RESULTS: Systematic documentation of methodological appraisal and peer review results using a structured abstract form. The focus group wrote a final report (clearing report) including methodological abstracts for each guideline, essential topics for a future German hypertension guideline based on examples from the appraised guidelines, comments and recommendations for health care policy markers in Germany. RESULTS: 11 out of 132 guidelines were in accordance with the formal minimal standard with a wide range range within the following domains: "description of the development process", "declaration of authors' independence", "explicit link between recommendations and the supporting evidence", "management options", "tools for implementation". None of the guidelines identified all the key identified by the focus group, such as: (1) definition of hypertension--epidemiology--health care problems--intended guideline users/goals, (2) blood pressure measurement, (3) medical history and physical examination, (4) case-finding/screening, (5) indications for referral, (6) risk-stratification, (7) diagnostic procedures, (8) therapeutic goals/indications for therapy, (9) nonpharmacological measures, (10), pharmacotherapy, (11) follow-up/patient education/motivation/compliance, (12) comorbidity, hypertension in childhood/elderly, pregnancy, (13) primary prevention, (14) quality assurance/quality management, (15) dissemination/implementation, (16) open questions/challenges for the future. SUMMARY POINTS: To improve the quality of hypertension management in Germany, the expert panel suggested to develop a national evidence-based guideline. This should follow internationally agreed criteria and procedures. The experts identified and reviewed 11 out of 132 hypertension, which might make useful contributions for a future German Hypertension guideline. The expert group identified 16 key topics for a national hypertension guideline.

Comorbidity↗
PubMed2001

Medical-economical aspects of high sensitivity C-reactive protein assay for the prediction of coronary heart disease. An analysis in Germany and Italy.

BACKGROUND: Elevated plasma concentrations of C-reactive protein (CRP) are associated with increased cardiovascular risk. We studied the cost-effectiveness of CRP determination in primary and secondary prevention settings in two European countries: Germany and Italy. METHODS: Using a decision analytic model we evaluated the costs and consequences of testing or not testing using a high sensitivity (hs)-CRP assay. In a primary prevention model we analyzed a hypothetical cohort of 300000 apparently healthy men divided into three age groups (35-44, 45-54 and 55-64 years). Individuals with CRP levels > 3 mg/l were administered either aspirin or statins according to lipid levels. The cohort was followed for 5 years. In the secondary prevention model hs-CRP testing was evaluated in a cohort of 10000 patients with total cholesterol levels < 4.52 mmol/l and a history of myocardial infarction or unstable angina. The two strategies tested were: 1) administer pravastatin only to those with high CRP values, and 2) treat all patients. The analysis was performed from the societal perspective. Event rates were obtained from epidemiological studies and clinical trials. RESULTS: In the primary prevention model, strategies including testing showed, for men aged 45 years and older, cost-effectiveness ratios between each life year saved (LYS) and cost savings in Germany equal to 10217euro and between each LYS and savings in Italy equal to 16950euro In the age group 35-44 years, therapy with aspirin showed cost-effectiveness ratios of 5318euro and 11203euro per LYS in Germany and in Italy respectively. The widespread use of statins showed an unfavorable cost-effectiveness profile: 44630euro per LYS in Germany and 36270euro per LYS in Italy. In the secondary prevention model, hs-testing for CRP can reduce the cost-effectiveness of pravastatin from 16400 to 6830euro per quality adjusted life year gained. Sensitivity analysis performed on the variables test price and costs of cardiovascular events resulted in minimal changes of the cost-effectiveness ratios. CONCLUSIONS: Both in the primary and the secondary prevention settings, hs-testing for CRP can better target individuals at higher risk, thus improving outcomes and resulting in a more cost-effective strategy.

Adult↗
PubMed1988

[Developmental continuities of psychoanalysis and psychotherapy in Germany since 1939].

The history of psychoanalysis in Germany during the Second World War must be seen in the context of institutional and professional developments along the lines of the intersection of medicine and psychology during the first half of the twentieth century. The moral ambiguities of the integration of psychoanalysis and psychotherapy into the structures of modern industrial society were magnified and brutally supplemented in the course of the partial professionalization of these disciplines in Germany under the Nazi dictatorship. A study of the continuities in the history of psychoanalysis and psychotherapy in Germany since 1939 can provide insight into the moral and practical vicissitudes of professionalism in modern society as well as into the social history of Germany under Hitler.

Germany↗
PubMed2002

[Management of patients with viral hemorrhagic fever in Germany a comparison with the current Japanese system based on the who guidelines on emerging viral diseases].

OBJECTIVES: We investigated the German system for managing patients with viral hemorrhagic fever (VHF) in comparing with the current Japanese system. METHODS: In Germany, we visited the Robert Koch Institute and the isolation centers in Berlin and Leipzig. In Japan, we visited the isolation wards in the Narita Red Cross Hospital and the Rinku General Medical Center in Izumi-Sano, Osaka, to allow determination of differences in the systems. In terms of the "WHO program on emerging virus diseases, 1994", we then evaluated the two countries' systems. RESULTS: In Germany, the finding of a suspected case with VHF is promptly reported to the competent authorities at the local level. Public health physicians on 24-hour duty declare a quarantine alert and the case is transferred to one of five isolation centers not by plane but by ambulance car. The isolation rooms in Berlin, constructed some 20 years ago, are enclosed with plastic film and kept under negative pressure and this hinders it difficult to perform intensive care in the small space available. In contrast, intensive care and routine clinical tests can be readily conducted in the isolation facilities in Leipzig installed in 2000, since the rooms are spacious and kept under negative pressure. It is also noteworthy that the same ward is utilized for patients with drug-resistant infectious diseases to train medical staff. With 3 of the 4 goals in the WHO program, establishing efficient surveillance of infectious diseases, provision of a qualified national laboratory and performance on practical research on infectious diseases, there are no large differences, between the two countries, in continuous efforts in line with recently-modified infectious disease laws. However, we found differences with regard to an effective strategy to circumvent VHF, 1) local government has a main role against VHF and control team is promptly designated in Germany, 2) only 10 beds are equipped to deal with VHF in Germany, 3) management of air-droplet infection seems insufficient in Japan, 4) highly-equipped isolation rooms are not utilized for patients other than those with VHF in Japan. CONCLUSIONS: These findings require urgent discussion among Japanese experts concerning; 1) operation of BSL4 facilities in national laboratories; 2) collaboration among quarantine stations, local government and national reference laboratories; 3) the appropriate number of isolation wards; 4) practical procedures to run of isolation wards efficiently; 5) the possibility of utilizing isolation wards for non-VHF.

Disease Management↗
PubMed2002

Low demand for substitutive voluntary health insurance in Germany.

AIM: To examine why the demand for substitutive voluntary health insurance in Germany is low. METHOD: A comparison of the benefits and costs of statutory and voluntary health insurance in Germany, based on a review of literature published in academic journals and books as well as gray literature. RESULTS: Employees in Germany with gross earnings over 40,500 Euros a year can choose to opt out of the statutory health insurance scheme (Gesetzliche Krankenversicherung, GKV) and purchase substitutive voluntary health insurance instead. Only a quarter of these employees and their dependents actually choose to opt out; the majority remain in the GKV. Substitutive voluntary health insurance does not generally afford greater benefits than the GKV in terms of services provided or choice of insurer and only affords marginal benefits in terms of choice of provider. It is also more expensive than the GKV for people with dependents, elderly people and people in poor health. Consequently, the choice to opt out and purchase substitutive voluntary health insurance is more likely to be taken by young, healthy or single people or couples with double incomes. CONCLUSION: Our analysis suggests that the demand for substitutive voluntary health insurance in Germany is low because the costs of opting out of the GKV are, in general, higher than the benefits afforded by purchasing substitutive voluntary health insurance. In the long term substitutive voluntary health insurance does not appear to provide good value for money when compared to the GKV, particularly for people with dependents, elderly people, and people in poor health.

Choice Behavior↗