Christian Hagist

Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection.

OBJECTIVE To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI). METHODS Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month. RESULTS The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P< .001). The multivariate analysis (R2=0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= .01), and lincosamides (P= .05). The multivariate analysis (R2=0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected. CONCLUSION In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.

The impact of antimicrobial drug consumption and alcohol-based hand rub use on the emergence and spread of extended-spectrum β-lactamase-producing strains: a time-series analysis

BACKGROUND The aim of this study was to explore the temporal relationship between the consumption of different antibiotics, alcohol-based hand disinfection and the incidence of nosocomial bacterial strains producing extended-spectrum beta-lactamases (ESBLs). METHODS Time-series analysis was performed based on monthly data available from January 2005 to October 2007. The incidence of nosocomial ESBL (cases/1000 patient-days) was regressed on the different antibiotic agents and the volume of alcohol-based hand rub orders. Antibiotic consumption was defined as monthly defined daily doses (DDD)/1000 patient-days, while alcohol-based hand rub was quantified in litres/1000 patient-days. RESULTS The multivariate analysis showed that using alcohol-based hand rub for hand disinfection had a significant influence on the ESBL incidence (P = 0.002). A higher volume of alcohol-based hand rub use was subsequently associated with a lower incidence of ESBL-producing strains. Additionally, the model showed that temporal increase in the use of third-generation cephalosporins (P = 0.022) and fluoroquinolones (P = 0.001) is, after a time lag of up to 3 months, followed by temporal variations in the incidence of nosocomial ESBLs. Furthermore, the incidence of patients admitted with ESBL was also shown to have an influence on the incidence of nosocomial ESBLs (P < 0.001). The final model explained 75% of the monthly variations in the incidence of nosocomial ESBLs. CONCLUSIONS The analysis identifies selective pressure caused by the use of different antimicrobial agents as a driving factor in the emergence and spread of ESBLs. Furthermore, the study confirms that hand disinfection is key to the prevention of nosocomial ESBLs.

Optional deductibles in social health insurance systems

A fundamental aspect of the German health insurance system is the principle of solidarity. At the same time, it is possible for certain socio-economic groups to opt out of the otherwise compulsory system. To determine whether rates incorporating deductibles are compatible with the principles of solidarity and have the ability to heighten the appeal of statutory health insurance (SHI) funds compared with private health insurance companies, Germany’s third largest SHI fund, Techniker Krankenkasse, implemented a pilot scheme involving the use of deductibles. Preliminary scientific evaluations of the pilot scheme indicate three main results for these deductibles: Firstly, they are compatible with the principles of solidarity in the statutory health insurance system; secondly, they provide an effective means of preventing defection to private health insurance companies and thirdly, they reduced the volume of insurance claims (moral hazard).

Friedens- versus Ausscheidegrenze in der Krankenversicherung: Ein kriegerischer Beitrag für mehr Nachhaltigkeit

ZusammenfassungDie private (PKV) und die gesetzliche Krankenversicherung (GKV) werden durch die so genannte Friedensgrenze getrennt. Um die daraus resultierende Risikoselektion zu vermindern, wird die Einführung einer so genannten Ausscheidegrenze nach niederländischem Vorbild mit Hilfe der Generationenbilanzierung untersucht. Aufgrund der Einkommensumverteilung innerhalb der GKV führt eine solche Reform nicht zu mehr Nachhaltigkeit. Jedoch kann eine Ausscheidegrenze eine positive Dynamik entfalten, wenn entweder ein System von Gesundheitsprämien in der GKV vorherrscht oder aber die PKV für die neuen Kunden eine „Ablöseprämie“ zahlt, die genau den Umfang der Einkommensverteilung dieser Gruppe ausmacht.AbstractThe German health insurance system is separated between the private and public sector by a social security ceiling. To reduce the risk selection of the current system we discuss the implications of the conversion of the upper income limit into a provision limit. Using a generational accounting approach, we find that such a conversion has a negative effect in respect of sustainability. In addition, we present the idea of a transfer premium, which reflects the value of the analyzed group of insurants. Our results show that with a transfer premium or in a system of lump-sum-premiums, the provision limit would have positive implications and would leave the German system more sustainable.

Generationengerechte Politik? Eine Analyse der aktuellen Politik der Bundesregierung anhand der Generationenbilanz

Die öffentliche Diskussion um das Rentenpaket und die Pflegereform der Bundesregierung besticht durch einen eigentümlichen Charakter. Denn sowohl die Gegner als auch die Befürworter dieser beiden zentralen Vorhaben des Koalitions-vertrages rechtfertigen ihre Ablehnung bzw. Zustimmung auf Grundlage eines Mangels an Generationengerechtigkeit. Vor dem Hintergrund dieser eigentümlichen Diskussion befasst sich der vorliegende Beitrag mit der Frage der Generationengerechtigkeit der aktuellen Politik der Bundesregierung. Anhand der Methodik der Generationenbilanzierung werden hierzu die intergenerativen Verteilungswirkungen des Rentenpaktes und der Pflegereform sowie deren Konsequenzen für die Nachhaltigkeit der öffentlichen Finanzen quantifiziert. Die Ergebnisse zeigen, dass die aktuelle Politik der Bundesregierung den jüngeren und zukünftigen Generationen zusätzliche Belastungen aufbürdet.

Oil and Intergenerational Redistribution - The Case of Norway

The Norwegian population will pass through an ageing process during the next decades which causes that the old-age-dependency ratio rises from currently 22 per cent up to 38 per cent in 2050 and 47 per cent in 2100. This ageing population induces increasing expenditures on old-age and disability pensions together with health and long-term care benefits while the public revenues from wage taxes and social contributions will decrease. At the same time, the revenues from petroleum activities decline. Therefore, it is unclear if the Norwegian fiscal policy is really sustainable or not even despite the formidable current conditions with a budget surplus of nearly 14 per cent of GDP and a net wealth of 26 per cent of GDP. Is Norway over-consuming its petroleum wealth?

Cui bono? - Die Bürgerversicherung und die Beihilfe

Zusammenfassung In der deutschen Gesundheitspolitik wird seit langem unter dem Stichwort Bürgerversicherung über die Einbeziehung aller Bürger in das System der Gesetzlichen Krankenversicherung diskutiert. Dabei wird meistens die Perspektive der GKV-Versicherten eingenommen, seltener diejenige der Versicherten der PKV. Es stellt sich jedoch insbesondere für die Gruppe der Beihilfeberechtigten die Frage, welche monetären Konsequenzen durch eine Bürgerversicherung für sie entstehen und in welcher Höhe daraus Kompensationszahlungen abgeleitet werden können. Die Ergebnisse zeigen: Selbst, wenn diese Kompensationen weniger als die Hälfte der Differenz der Versicherungsleistungen zwischen PKV/Beihilfe und einer Bürgerversicherung abdecken, hat der Business case Bürgerversicherung für die Gebietskörperschaften zumindest kurzfristig negative fiskalische Folgen.

The Effect of Digitalization on the Labor Market

Digitalization has opposing effects on labor markets. Although the overall pie might grow bigger, severe structural changes and therefore challenges for society at large will definitely occur. For this reason, we want to address the following questions: How will digitalization change the division of work? Which jobs are at stake? And will demography be a factor in this regard? In economic textbooks, we normally assume that new technology drives growth and therefore has also a net positive impact on employment. For the past, this was certainly true, as the replacement of the typewriter by personal computers still required a person behind a desk, which now however could offer more and better services. This relationship between technology and the labor market might be about to change in our digitalization era. Already today, some news are written by the computer itself—without human fingers typing. The new feature of this technological change is therefore that not only muscle but also brain work will be replaced by robots—given it is not only technological feasible but also cost-efficient. In addition to the general change by digitalization of work processes, it could be the case that societies have to react differently to this ongoing process given their demographic transition and their education system. Research suggests that the conflict will not only evolve between capital and labor but also between young and old workers, as rationing will disproportionately affect the young. Perplexedly, it might even be the case that rapid aging countries like Japan or Germany will have less problems regarding the labor market.

Resistance Elasticity of Antibiotic Demand in Intensive Care

The emergence and spread of antimicrobial resistance (AMR) is still an unresolved problem worldwide. In intensive care units (ICUs), first-line antibiotic therapy is highly standardized and widely empiric while treatment failure because of AMR often has severe consequences. Simultaneously, there is a limited number of reserve antibiotics, whose prices and/or side effects are substantially higher than first-line therapy. This paper explores the implications of resistance-induced substitution effects in ICUs. The extent of such substitution effects is shown in a dynamic fixed effect regression analysis using a panel of 66 German ICUs with monthly antibiotic use and resistance data between 2001 and 2012. Our findings support the hypothesis that demand for reserve antibiotics substantially increases when resistance towards first-line agents rises. For some analyses the lagged effect of resistance is also significant, supporting the conjecture that part of the substitution effect is caused by physicians changing antibiotic choices in empiric treatment by adapting their resistance expectation to new information on resistance prevalence. The available information about resistance rates allows physicians to efficiently balance the trade-off between exacerbating resistance and ensuring treatment success. However, resistance-induced substitution effects are not free of charge. These effects should be considered an indirect burden of AMR. Copyright

Die Methode der Generationenbilanzierung

Staatsschulden sind derzeit das beherrschende Thema in Europa. Doch das, was allgemein als Staatsschulden bezeichnet wird, ist nur ein Teil der wahren Staatsverschuldung, da die implizite Staatsverschuldung nicht berücksichtigt wird. Ein Ausweg aus dieser Situation ist das Messkonzept der Generationenbilanzierung, welches die Staatsverschuldung auf Basis der intertemporalen Budgetrestriktion des Staates bestimmt. Der Beitrag diskutiert die Methodik der Generationenbilanzierung und erläutert die Ergebnisse der deutschen Generationenbilanz 2010.