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Background The COVID-19 pandemic was a health emergency requiring rapid scal resource mobilisation to support national responses. The use of e ective health nancing mechanisms and policies, or lack thereof, a ected the impact of the pandemic on the population, particularly vulnerable groups and individuals. We provide an overview and illustrative examples of health nancing policies adopted in 15 countries during the pandemic, develop a framework for resilient health nancing, and use this pandemic to argue a case to move towards universal health coverage (UHC). Methods In this case study, we examined the national health nancing policy responses of 15 countries, which were purposefully selected countries to represent all WHO regions and have a range of income levels, UHC index scores, and health system typologies. We did a systematic literature review of peer-reviewed articles, policy documents, technical reports, and publicly available data on policy measures undertaken in response to the pandemic and complemented the data obtained with 61 in-depth interviews with health systems and health nancing experts. We did a thematic analysis of our data and organised key themes into a conceptual framework for resilient health nancing. Findings Resilient health nancing for health emergencies is characterised by two main phases: (1) absorb and recover, where health systems are required to absorb the initial and subsequent shocks brought about by the pandemic and restabilise from them; and (2) sustain, where health systems need to expand and maintain scal space for health to move towards UHC while building on resilient health nancing structures that can better prepare health systems for future health emergencies. We observed that ve key nancing policies were implemented across the countries— namely, use of extra-budgetary funds for a swift initial response, repurposing of existing funds, e cient fund disbursement mechanisms to ensure rapid channelisation to the intended personne

Governments seek universal health care to guarantee citizens equal treatment and improve health at the individual and group levels. Scientific articles were searched in databases such as Scielo, Science Direct, Google Scholar y Scopus. The search was limited to publications between 2019 and 2023 in Spanish or English, and freely available. As a result, social marketing is crucial to address public health problems and has been widely used for decades to change behaviors. It is concluded, social marketing promotes health, prevents disease and improves quality of life. It focuses on specific groups, understands needs, and analyzes external factors to generate change. It involves the public and institutions from different sectors through a multidisciplinary team. This has a positive impact on health programs and can influence the behavior of beneficiaries., Los gobiernos buscan atención universal de salud para garantizar a los ciudadanos igualdad de trato y mejorar la salud a nivel individual y grupal. Se buscaron artículos científicos en bases de datos como Scielo, Science Direct, Google Scholar y Scopus. Se limitó la búsqueda a publicaciones entre 2019 y 2023 en español o inglés, y de acceso gratuito. Como resultado, el Marketing social es crucial para abordar los problemas de salud pública y ha sido ampliamente utilizado durante décadas para cambiar comportamientos. Se concluye, el mercadeo social promueve la salud, previene enfermedades y mejora la calidad de vida. Se enfoca en grupos específicos, comprende necesidades y analiza factores externos para generar cambios. Involucra al público y a instituciones de diferentes sectores a través de un equipo multidisciplinario. Esto tiene un impacto positivo en los programas de salud y puede influir en el comportamiento de los beneficiarios.

We examine how the coverage expansion of universal health care (UHC) affects the private health insurance (PHI) market and welfare using a quantitative macroeconomic model. Reduced medical expenditure and risk by the UHC coverage expansion leads individuals to save less and purchase less of PHI. The raised UHC premium to finance the coverage expansion discourages individuals to work since UHC is primarily financed by an earmarked payroll tax. Although the aggregate level labor, capital, output, and PHI take-up ratio decrease, welfare increases monotonically with the coverage expansion with the redistribution effect toward the old and the poor.

Introduction: Our study aimed to identify factors that influence access to eye care and eye health outcomes for remote Indigenous Australians living with diabetes. Methods: In collaboration with Indigenous Community Based Researchers (CBRs) and Aboriginal Community Controlled Health Services (ACCHSs), a qualitative, participatory action research approach was taken, drawing on Indigenist and decolonising methodologies. The study was undertaken in four remote communities, in the Katherine Region, Northern Territory, and North Western New South Wales, Australia. Interviews and focus groups were undertaken with Indigenous adults aged ≥ 40 years living with diabetes (n=110), and primary care clinicians working in ACCHSs (n=37). A series of interviews with CBRs (n=13) were undertaken pre and post data collection to add cultural insights and validation to participant accounts. Data were analysed inductively using in-depth discussion and Nvivo 11. Results: More than one third of all patients had little to no knowledge of how diabetes affects eye health. Limited access to health information and interpreters, language barriers, distrust of health providers and services, and limited cultural responsivity among non-Indigenous clinicians, were identified as determining factors in eye health and care. Discussion: We outline a need to address gaps in trust and communication, through increased access to and resourcing of Indigenous language interpreters and cultural brokers, understandable and culturally sensitive diabetic eye health information, and cultural responsivity training for non-Indigenous clinicians. Centering Indigenous cultures in health care practice will enable a shared understanding between clinicians and Indigenous patients, and subsequently more equitable eye health outcomes.

Universal health care (UHC) is primarily a financing concern, whereas primary health care (PHC) is primarily concerned with providing the right care at the right time to achieve the best possible health outcomes for individuals and communities. A recent call for contributions by the WHO emphasized that UHC can only be achieved through PHC, and that to achieve this goal will require the strengthening of the three pillars of PHC - (a) enabling primary care and public health to integrate health services, (b) empowering people and communities to create healthy living conditions, and (c) integrating multisectoral policy decisions to ensure UHC that achieves the goal of "health for all." "Pillars" - as a static metaphor - sends the wrong signal to the research and policy-making community. It, in fact, contradicts the WHO's own view, namely that there is "the need to strengthen comprehensive primary health care systems based on local priorities, needs and contexts ... [that are] co-developed by people who are engaged in their own health." What we really need to develop PHC as the basis to achieve the goal of UHC is a dynamic agency to drive a "system-as-a-whole framework" that simultaneously takes into account finance, individual, and local needs. Health systems are socially constructed organizational systems that are "functionally layered" in a hierarchical fashion - governments and/or funders at the top-level not only promote the goals of the system (policies) but also constrain the system (rules, regulations, resources) in its ability to deliver. Hence, there is a need to focus on two key system features - political leadership and dynamic bottom-up agency that maintains everyone's focus on the goal to be achieved, and a limitation of system constraints so that communities can shape best adapted primary care services that truly meet the needs of their individuals, families, and community.Copyright © 2020 John Wiley & Sons, Ltd.

Universal health care (UHC) is primarily a financing concern, whereas primary health care (PHC) is primarily concerned with providing the right care at the right time to achieve the best possible health outcomes for individuals and communities. A recent call for contributions by the WHO emphasized that UHC can only be achieved through PHC, and that to achieve this goal will require the strengthening of the three pillars of PHC - (a) enabling primary care and public health to integrate health services, (b) empowering people and communities to create healthy living conditions, and (c) integrating multisectoral policy decisions to ensure UHC that achieves the goal of "health for all." "Pillars" - as a static metaphor - sends the wrong signal to the research and policy-making community. It, in fact, contradicts the WHO's own view, namely that there is "the need to strengthen comprehensive primary health care systems based on local priorities, needs and contexts ... [that are] co-developed by people who are engaged in their own health." What we really need to develop PHC as the basis to achieve the goal of UHC is a dynamic agency to drive a "system-as-a-whole framework" that simultaneously takes into account finance, individual, and local needs. Health systems are socially constructed organizational systems that are "functionally layered" in a hierarchical fashion - governments and/or funders at the top-level not only promote the goals of the system (policies) but also constrain the system (rules, regulations, resources) in its ability to deliver. Hence, there is a need to focus on two key system features - political leadership and dynamic bottom-up agency that maintains everyone's focus on the goal to be achieved, and a limitation of system constraints so that communities can shape best adapted primary care services that truly meet the needs of their individuals, families, and community.Copyright © 2020 John Wiley & Sons, Ltd.

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organization's initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organization's initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

Kidney transplant provides superior outcomes to dialysis as a treatment for end-stage kidney disease. Therefore, it is essential that kidney transplantation be part of an integrated treatment and management plan for chronic kidney disease (CKD). Developing an effective national program of transplantation is challenging because of the requirement for kidney donors and the need for a multidisciplinary team to provide expert care for both donors and recipients. This article outlines the steps necessary to establish a national kidney transplant program, starting with the requirement for effective legislation that provides the legal framework for transplantation whilst protecting organ donors, their families, recipients, and staff and is an essential requirement to combat organ trafficking. The next steps involve capacity building with the development of a multiskilled workforce, the credentialing of transplant centers, and the reporting of outcomes through national or regional registries. Although it is accepted that most transplant programs will begin with living related kidney donation, it is essential to aspire to and develop a deceased donor program. This requires engagement with multiple stakeholders, especially the patients, the general community, intensivists, and health departments. Development of transplant centers should be undertaken in concert with the development of a dialysis program. Both are essential components of integrated care for CKD and both should be viewed as part of the World Health Organizations initiative for universal health coverage. Provisions to cover the costs of treatment for patients need to be developed taking into account the state of development of the overall health framework in each country.

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual ser

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual ser

PURPOSE OF THE REVIEW: In 2015, antiretroviral therapy (ART) was recommended for all people living with HIV (PLHIV) regardless of CD4 count (Treat All). To better understand how to improve linkage to care under these new guidelines, we conducted a systematic review of studies evaluating linkage interventions in Sub-Saharan Africa under Treat All. RECENT FINDINGS: We identified 14 eligible articles and qualitatively analyzed the effectiveness of the interventions. Increases in linkage were reported by supply-side and counseling interventions. Mobile testing and economic incentives did not increase linkage. Given the lag time between adoption and implementation, only two of the studies were conducted in a Treat All setting. None of the interventions specifically focused on re-linking PLHIV who had disengaged from care. Future studies must design interventions that target not only newly diagnosed or treatment naïve PLHIV, but should explicitly focus on PLHIV who have disengaged from care.

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual ser

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual ser

Background: A key challenge for most systems is how to provide effective access to urgent and emergency care across rural and urban populations. Tensions about the placement and scope of hospital emergency services are longstanding in Irish political life and there has been recent reform to centralise hospital services in some regions. The focus of this paper is a system approach to examine the geographic variation in resourcing and utilisation of such care across GP practices, out-of-hours care, ambulance services, Emergency Departments and Local Injury Units in Ireland. Methods: We used a cross-sectional study design to evaluate variation in resource allocation by aggregating geographic funding to various elements of the urgent and emergency care system and assessing patterns in hospital resource utilisation across the population. Expenditure, staffing, access and activity data were gathered from government sources, individual facilities and service providers, health professional bodies, private firms and central statistics. Data on costs and activity in 2014 are collated and presented at both county and regional levels. Analyses focus on resources spent on urgent and emergency care across geographic areas, the role of population concentration in allocation, the relationship between pre-hospital spending and in-hospital spending, and the utilisation of hospital-based emergency care resources by residents of each county. Results: An array of funding mechanisms exists, resulting in a fragmented approach to the resourcing of urgent and emergency care. There are large differences in spending per capita at the county-level, ranging from between €50 and €200 per capita; however, these are less pronounced regionally. Distribution of hospital emergency care resources is highly skewed to the North East of the country, and away from the recently reconfigured South and Mid-West regions. Conclusions: This analysis advances the traditional approach of evaluating individual ser

Many low-income and middle-income countries use national eye care plans to guide efforts to strengthen eye care services. The World Health Organization recognises that evidence is essential to inform effective eye care plans. We assessed the incorporation of evidence in a sample of national eye care plans generated since the Universal eye health: a global action plan 2014-2019 was endorsed by the World Health Assembly in 2013. With the exceptions of citing prevalence of blindness estimates and setting cataract surgical rate targets, evidence was rarely cited or used to setmeasurable targets. This limited use of evidence reflects the low availability of relevant eye health evidence, but also highlights incomplete use of existing evidence. For example, despite surveys routinely disaggregating prevalence data by sex, only one-third of countries reported estimates forwomen and men separately, and only three countries established sex-disaggregated indicators for future monitoring. Looking ahead, countries almost universally recognised the need to strengthen health information systems and almost one-third planned to undertake operational or intervention research. Realistic strategies need to be identified and supported in order to translate these intentions into action. To gain insights into how a country can strengthen its evidence-informed approach to eyecare planning, we reflect on the process underway to develop Kenya’s eighth national plan (2019-2023). The nature and extent of available eye health evidence in Kenya are outlined, the process to strengthen incorporation of evidence into the forthcoming plan is outlined, and enabling factors aredescribed.

Nachdem jedwede Ansätze zu einer Bürgerversicherung keine Aufnahme in den Koalitionsvertrag von CDU, CSU und SPD zur Regierungsbildung im Jahr 2018 in Deutschland gefunden hatten, richtete sich danach der Blick verstärkt auf die landespolitischen Ebenen: Die Freie und Hansestadt Hamburg eröffnete ihren neu ernannten Beamten ab August 2018 die Wahl: Sie können seitdem entweder die individuelle Beihilfe erhalten oder aber stattdessen eine Pauschale, die dem halben Beitrag zur GKV entspricht. Damit wird dort für neue und junge Beamte ihre Einbeziehung in die GKV erleichtert. Aber ist der Wechsel in die GKV für Beamte auch finanziell attraktiv? Weist das Hamburger Modell wirklich einen Weg in Richtung Bürgerversicherung? Oder ebnet es der Etablierung eines liberalen Versicherungsmarkts den Weg, auf dem dann verschiedene gesetzliche und private Versicherungen untereinander und miteinander um Kunden konkurrieren, denen der Gesetzgeber zwar abstrakt eine Versicherungspflicht vorschreibt, ihnen aber eine Wahlmöglichkeit hinsichtlich einer gesetzlichen oder privaten Versicherung und ggf. auch hinsichtlich des Leistungsumfangs einräumt? Methodisch wird mit einer ersten Simulationsrechnung auf mikro-ökonomischer Ebene für das Jahr 2015 am Beispiel einzelner typisierter Beamter des mittleren, gehobenen und höheren Dienstes des Landes Baden-Württemberg, d. h. für Beamte mit unterschiedlich hohen Einkommen, geprüft, ob und inwiefern ihre Einbeziehung in die GKV mitsamt Übernahme der Arbeitgeberbeiträge durch ihre Dienstherren auch zu ihrem eigenen Vorteil wäre. Methodisch werden dann die GKV-Beiträge von drei typischen Verwaltungsangestellten für die Jahre 1985, 1995 und 2005 berechnet und mit der Entwicklung der PKV-Prämien für Beamte derselben Jahre auf Basis des SOEP und mit der Entwicklung der Nominallöhne verglichen. Abschließend wird die Hamburger Gesetzesinitiative für eine einmalige Wahlmöglichkeit zwischen GKV und Privater Krankenversicherung (PKV) für neue/junge Beamte

This article examines the impact of Seguro Popular (SP) in health services utiliza-tion, in the labor market, and in household health expenditures. Beneï¬ting from longitudinal data from the Mexican Family Life Survey, we use propensity score matching techniques to analyze the data by gender and population origin. In gen-eral, the SPhas not impacted the number of hospitalizations and out-patient con-sultations, with the exception of urban women. The analysis by institution shows that, in urban populations, the SPhas increased external consultations in the health care facilities provided by the Health Ministry. The SPshows a negative impact in the Mexican Institute of Social Security coverage, and in the formal employment of urban women and rural men. At the household level, we do not ï¬nd any effect on household health expenditures.

This article examines the impact of Seguro Popular (SP) in health services utiliza-tion, in the labor market, and in household health expenditures. Beneï¬ting from longitudinal data from the Mexican Family Life Survey, we use propensity score matching techniques to analyze the data by gender and population origin. In gen-eral, the SPhas not impacted the number of hospitalizations and out-patient con-sultations, with the exception of urban women. The analysis by institution shows that, in urban populations, the SPhas increased external consultations in the health care facilities provided by the Health Ministry. The SPshows a negative impact in the Mexican Institute of Social Security coverage, and in the formal employment of urban women and rural men. At the household level, we do not ï¬nd any effect on household health expenditures.

Mexico's leadership finds itself confronted with a variety of thorny governance issues including immigration, drug trafficking, and education. Alongside these seemingly unsolvable problems lies the issue of health care, which is primarily a good news story. The Mexican government has always taken a paternalistic approach to health care to the extent that access to care is a constitutional right. Nationally, Mexico's medical industry has demonstrated the ability to provide a quality of care on par with global leaders, but there are inequities in quality and availability of care as one dissects matters socioeconomically and geographically. This paper looks at the practicality of a U.S. partnership with the government of Mexico in tackling these perceived inequities against a backdrop of competing priorities. Finally, the paper concludes with a recommended course of action that not only addresses health care delivery, but also is compatible with complementary security and stability efforts.

With a new government in place since January and a woman, Dilma Rousseff, at the helm, together with an economic growth rate of 7·5% last year and a newly discovered oil field off its coast, Brazil is a country in demand as a political and economic partner. Brazil now has an important and timely opportunity to cement its formidable health achievements towards its ultimate goal of universal, equitable, and sustainable health care to fulfil the right to health enshrined in its 1988 constitution. To highlight this opportunity, The Lancet is publishing a Series of six papers that critically examine what the country's policies have achieved and where future challenges might lie.

Die Analyse beschäftigt sich mit der Möglichkeit der Einführung einer Bürgerversicherung im Bereich der Sozialen und Privaten Pflegeversicherung in Deutschland. Unter einer Bürgerversicherung wird dabei die Einbeziehung der gesamten Bevölkerung in Deutschland sowie die Einbeziehung aller Einkommensarten des Steuerrechts - mit Ausnahme von Mieteinkommen - in die Beitragsbemessung verstanden. Der Schwerpunkt der Untersuchung besteht in der Abschätzung des erzielbaren Beitragsaufkommens und darauf aufbauend in der Behebung der momentan zu beobachtenden Unterdeckung in der Sozialen Pflegeversicherung. In weiteren Schritten werden die Beitragssätze für die nächsten 20 Jahre auf der Basis eines ausgeglichenen Haushalts für die Pflegeversicherung als Bürgerversicherung ermittelt. Zu Grunde gelegt wird der Gesetzesstand zu Beginn des Jahres 2005, also bereits unter Einbeziehung der Anhebung des Beitragssatzes für Versicherte ohne Kinder. Als Grundlage der Berechnungen dienen die Daten des Sozio-ökonomischen Panels (SOEP) von 2002 des Deutschen Instituts für Wirtschaftsforschung (DIW), einer repräsentativen Stichprobe mit jährlich mehr als 22.000 Befragten. Die zentralen Ergebnisse lauten: (1) Die Analyse zeigt, dass eine Anhebung des Beitragssatzes von derzeit 1,7% bis 2007 nicht notwendig wird. (2) Ohne Einführung der Bürgerversicherung würde der Beitragssatz bis zum Jahre 2025 auf 2,33% demographiebedingt steigen. Mit der Verbesserung der Versorgung für Demenzerkrankte und der Anpassung der Pflegesätze in der ambulanten Pflege würde der Beitragssatz auf 2,52% steigen. (3) Durch die Einführung einer Bürgerversicherung könnte der Beitragssatz im Jahr 2006 auf 1,50% gesenkt werden einschließlich der verbesserten Versorgung Demenzkranker und der Anhebung ambulanter Pflegesätze. (4) Würde man bei Einführung der Bürgerversicherung den Beitragssatz von 1,7% beibehalten, könnten bis zum Jahr 2015 Rücklagen in der Bürgerversicherung Pflege angespart werden. (5) Ohne Ansparung von

'Das Prinzip der Bürgerversicherung: Alle Bürger und alle Einkommensarten tragen bei, dann sinken die Beitragssätze. Die Finanzierung der gesetzlichen Krankenversicherung leidet darunter, dass die Beiträge nur auf Löhne und Gehälter erhoben werden, und die Bürger mit den höchsten Einkommen und der besten Gesundheit zu einem großen Anteil nicht in dem solidarischen System mit versichert sind. Somit sind sowohl der Versichertenkreis als auch die Einkommensbasis zu schmal. Die gesetzliche Krankenversicherung ist in gewissem Sinne ein System der 'Solidarität der Schwachen', weil sich Gutverdienende, Selbstständige und Beamte dem System systematisch entziehen können, um sich privat zu versichern. Da Gesundheit in Deutschland wie in allen anderen Industrieländern mit dem Einkommen und der Bildung korreliert, verliert das gesetzliche Krankenversicherungssystem insbesondere die Mitglieder, die gleichzeitig einkommensstärker und gesünder als der Durchschnitt sind. Mit jedem Mitglied, welches die gesetzliche Krankenkassen als so genannter freiwillig Versicherter verlässt, verliert die Gesetzliche Krankenkasse nach Berücksichtigung der Kosten des Mitglieds etwa 3.500 Euro jährlich. Dazu kommt, dass durch die Beschränkung der Beitragsbasis auf Löhne und Gehälter die Beitragssätze der gesetzlichen Krankenversicherung immer dann steigen, wenn es mehr Arbeitslose oder Kurzarbeiter gibt. Der dann folgende Beitragssatzanstieg trägt wiederum zur Erhöhung der Arbeitslosigkeit bei, ein Teufelskreis. Das relativ stärkere Wachstum von Einkommen aus Selbständigkeit oder Kapitaleinkünften steht für die Finanzierung der gesetzlichen Krankenversicherung kompensatorisch aber leider nicht zur Verfügung. Die Bürgerversicherung dient daher der konsequenten Bekämpfung der beiden Hauptursachen für steigende Beitragssätze. Sie schließt zukünftig auch die Gutverdienenden, Beamten und Selbstständigen in das solidarische System der Krankenversicherung ein. Außerdem würden auch Beiträge auf Miet-, Zins

Der auf der "Sonntagsmatinee" im September 2003 gehaltene Vortrag resümiert das Reformwerk der "Rürup-Kommission" hauptsächlich unter dem Gesichtspunkt einer "nachhaltigen Sozialpolitik". Nachhaltigkeit ist nicht gleichbedeutend mit Generationengerechtigkeit. Es gibt weder ein "gerechtes Rentenniveau", noch können die positiven Wachstumseffekte bzw. Arbeitsangebots- und Nachfrageelastizitäten infolge einer Absenkung der Lohnnebenkosten für Jahrzehnte hinaus genau quantifiziert werden. Klar ist nur, dass die Generationen in Zukunft in stärkerem Maße für soziale Sicherung selbst aufkommen müssen, weil nur so die Konsequenzen der demografischen Alterung sicher nicht gleichmäßig, wohl aber gleichmäßiger verteilt werden können. In welchem konkreten Maße die gleichmäßigere Verteilung aber geschehen soll, lässt sich wissenschaftlich nicht bestimmen. Dies muss dem Austarierungsprozess in der Sozialpolitik überlassen bleiben. Denn auch nachhaltige Sozialpolitik ist Verteilungspolitik, Verteilungspolitik im Längsschnitt. Eng verbunden mit Nachhaltigkeit in der Sozialpolitik ist daher auch ein neues Verständnis von sozialer Gerechtigkeit. Neben der interpersonellen Einkommensumverteilung und dem intrapersonellen Transfer von Einkommenspositionen der Erwerbsphase in die Nichterwerbsphase muss es in Zukunft - auch und mehr - um eine bessere Verteilung von wirtschaftlichen Chancen - insbesondere zugunsten der Jungen - und Finanzierungslasten der Systeme gehen. (ICA2)

Der Thüringische CDU-Ministerpräsident Dieter Althaus kombiniert in seinem Reformentwurf eines "Solidarischen Bürgergelds" den Ansatz eines bedingungslosen Grundeinkommens mit einer einheitlichen Kranken- und Pflegeversicherungsprämie. Diese Kombination wird analysiert, da aus ihr eine bemerkenswerte Problemlösung resultiert, die außerdem aufschlussreich ist im Hinblick auf die in der heutigen sozialpolitischen Reformdebatte verstärkt diskutierte Frage der Kombination des Grundeinkommensansatzes mit anderen Reformelementen.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

Anna Zavalskaya Radcliff, a Senior Account Executive met her American husband on a German dating website and married in Post-Communist Russia. Anna details life under Communism, life after Communism and her new life in America. Societal aspects were very similar and yet dissimilar however, Anna was able to conquer her fears and anxieties and is now successful and happy in the United States.

The quality of health care in the United States is not commensurate with its cost. Americans pay more per capita for health care than citizens of any other country in the world, yet population health trails that of developed nations that spend far less. Moreover, an astounding 15% of Americans lack health care coverage. Although some argue that the United States can claim a quality of health care among the highest in the world, costs in fact are soaring out of proportion to the quality of care provided to the population as a whole. Market failures prevent the health care industry from reaching its best potential efficiency in terms of resource allocation. Government and private industry spending on health care threatens an impending national fiscal crisis as Americans age but live longer with chronic diseases while engaging in unhealthy lifestyles that cause problems such as obesity. The United States must control costs while ensuring broad access to high-quality care. Without conceptual unity among Americans regarding fundamental health care values and objectives, health care costs will likely continue to grow out of proportion to the quality of and access to care provided to the population as a whole. Development now of a National Health Strategy provides the best chance to produce the needed fundamental change in time to avert approaching fiscal disaster., The original document contains color images.