German Pension Fund Research Articles

Machine learning-based identification of determinants for rehabilitation success and future healthcare use prevention in patients with high-grade, chronic, nonspecific low back pain: an individual data 7-year follow-up analysis on 154,167 individuals.

To individually prescribe rehabilitation contents, it is of importance to know and quantify factors for rehabilitation success and the risk for a future healthcare use. The objective of our multivariable prediction model was to determine factors of rehabilitation success and the risk for a future healthcare use in patients with high-grade, chronic low back pain. We included members of the German pension fund who participated from 2012 to 2019 in multimodal medical rehabilitation with physical and psychological treatment strategies because of low back pain (ICD10:M54.5). Candidate prognostic factors for rehabilitation success and for a future healthcare use were identified using Gradient Boosting Machines and Random Forest algorithms in the R-package caret on a 70% training and a 30% test set. We analysed data from 154,167 patients; 8015 with a second medical rehabilitation measure and 5161 who retired because of low back pain within the study period. The root-mean-square errors ranged between 494 (recurrent rehabilitation) and 523 (retirement) days ( R2 = 0.183-0.229), whereas the prediction accuracy ranged between 81.9% for the prediction of the rehabilitation outcome, and 94.8% for the future healthcare use prediction model. Many modifiable prognostic factors (such as duration of the rehabilitation [inverted u-shaped], type of the rehabilitation, and aftercare measure), nonmodifiable prognostic factors (such as sex and age), and disease-specific factors (such as sick leave days before the rehabilitation [linear positive] together with the pain grades) for rehabilitation success were identified. Inpatient medical rehabilitation programmes (3 weeks) may be more effective in preventing a second rehabilitation measure and/or early retirement because of low back pain compared with outpatient rehabilitation programs. Subsequent implementation of additional exercise programmes, cognitive behavioural aftercare treatment, and following scheduled aftercare are likely to be beneficial.

How the provision of inflation information affects pension contributions: A field experiment

AbstractIgnoring the effects of inflation in retirement planning can have severe consequences for an individual's future financial well‐being. Yet, many pension funds do not communicate inflation‐related information, presumably for the fear of reduced contributions once the members understand how low the “real” return on saving for retirement is. As an alternative prediction, the provision of inflation information could increase pension contributions, because it reveals possible pension shortfalls. In cooperation with a major German pension fund, we conduct a field experiment, in which we vary the inflation information provided to the fund members, to explore this important issue. Among all participants, we find mostly positive but insignificant effects of the inflation information on pension contributions. Among those participants who voluntarily changed their pension contributions after the experimental intervention, the provision of inflation information significantly raises the likelihood of increasing pension contributions.

Earnings Trajectories After Divorce: The Legacies of the Earner Model During Marriage

Divorce marks the legal endpoint of a marital union. While divorce is increasingly seen as a ‘clean break’, the past marital history of the couple may nevertheless shape their present conditions. In particular, there may be a legacy of a highly gendered division of labour during marriage that may affect the ex-spouses’ earning trajectories beyond the date of divorce. Using register data from the German Pension Fund, we examine the earning trajectories of heterosexual couples who filed for a divorce in 2013 (24,616 men and 24,616 women). Using fixed-effects and matching techniques, we compare the earning trajectories of divorcees with those of a control group of married persons in the period spanning two years before and two years after divorce. In particular, we examine how the earner models divorcees followed during marriage shaped their future earning trajectories. Our results show that, on average, the earnings of a divorced woman in a male breadwinner constellation increased after divorce, while the earnings of her male ex-spouse declined. Nevertheless, large gender differences in earnings persisted: 2 years after separation, a divorced woman who had been in a male breadwinner constellation was, on average, earning 72% less than her ex-spouse. We discuss our findings against the background of recent policy reforms in Germany, which assume that ex-partners should be economically ‘self-reliant’ after divorce.

Trauma rehabilitation : Implementation and challenges

The current state of posttraumatic rehabilitation in Germany is on the one hand shaped by the efforts of the primary care providers in the acute setting to transfer patients as soon as possible to rehabilitation in accordance with the requirement for acontinuous chain of rehabilitation. On the other hand, there are still important treatment gaps due to a lack of options, specialized structures and financing. This has the consequence that severely injured patients sometimes experience substantial difficulties, setbacks and delays on their way back to social participation. This article presents the various phases of rehabilitation and the existing challenges in order to guarantee the universally acknowledged demand for acontinuous rehabilitation chain. Reference is made to the missing structures and simultaneously to the necessary continuity of the processes, the quality assurance and the financial prerequisites for new forms of care. This is exemplified by how the continuum of posttraumatic rehabilitation of the German statutory accident insurance with the successful reintegration of trauma victims in work and social life could be amodel for insured persons of the statutory health insurance and the German pension fund. The scientific societies of trauma surgery and rehabilitation medicine also promote the model of a differentiated trauma rehabilitation and sustain the idea of atrauma rehabilitation network to increase the chances of the severely injured for the best possible quality of life and social participation.

Adherence to exercise and fitness following exercise-based outpatient cardiac rehabilitation: a cross-sectional survey for Germany

BackgroundExercise-based cardiac rehabilitation is safe and effective, evidence-based and implemented in national and international cardiac rehabilitation guidelines. Recent data show a decrease in cardiovascular mortality, reduced hospital admissions and an overall improvement in quality of life. To maintain positive effects and to prevent further cardiovascular events a major goal of cardiac rehabilitation is to induce a long-term health behaviour change and the integration of regular physical activity and exercise training in everyday life. The aim of this study is to evaluate the adherence of cardiac patients to exercise-based programs following rehabilitation phase III.MethodsA nationwide online cross-sectional survey was conducted. All outpatient aftercare providers who offer sports rehabilitation programs (heart groups) for cardiac patients in Germany were contacted. The questionnaire comprised 15 questions in five subcategories (general information regarding the outpatient aftercare provider, structure of rehabilitation sport programs, membership structure, content of heart groups, adherence to exercise-based programs).Results560 of 2447 outpatient aftercare providers participated in the survey (response rate: 23%). On average, rehabilitation sport facilities hosted 2 (IQR 2) heart groups per week, and 23 patients (IQR 30) (61% males; 31% females) per facility completed rehabilitation sport prescription in 2018. Almost all providers offer follow-up programs on a self-payer basis after rehabilitation sport prescription ends. Adherence to follow-up programs was at 54% (IQR 65; 55% males and 50% females). With 60% (IQR 71), patients with a statutory health insurance (mainly pensioners) adhere slightly more often to a follow-up program compared to privately insured persons (mainly population with a high income or civil servants) with 50% and significantly more often compared to persons who were insured by the German pension fund (covering working population) with only 9% (IQR 89) adherence.ConclusionAlmost all outpatient aftercare providers offer follow-up programs for cardiac rehabilitation patients but only half of them actually participate. Younger people (working population) do not adhere sufficiently to sport and exercise programs following rehabilitation phase III. This seems critical to address in terms of achieving long-term rehabilitation goals.

Does the Mortality of Individuals with Severe Disabilities Contribute to the Persistent East–West Mortality Gap Among German Men?

After three decades since reunification male life expectancy in East Germany still lags behind that of West Germany. Unlike most of the prior studies focusing on the role of socioeconomic factors, this study aims at assessing the contribution of the population with severe disabilities to the persistent East–West male mortality gap. Our analysis is mainly based on the German Pension Fund data. It is restricted to men aged 30–59 receiving disability pension (DP). We estimate mortality indicators and compare trends among populations with or without DP. We use decomposition method to quantify the effects of changes in mortality and compositional changed in the prevalence of receiving DP on the East–West mortality difference. The analysis covers the period 1995–2013. The German Socioeconomic Panel data and Cox proportional hazard models are used to evaluate the regional differences in the risk of receiving DP. Our results suggest that both the higher prevalence of receiving DP in the East and the higher mortality level among men not receiving DP in the East explain the East–West gap. The mortality difference among those receiving DP is negligible and does not contribute much to it. The observed higher prevalence in receiving DP in the East is very likely to reflect the reality as we found no regional differences in the risk of transitioning to receiving DP. The disadvantageous position of the East can be explained by the post-reunification crisis which particularly hit young men in the 1990s, selective migration from East to West after reunification, and the higher proportion of the healthier foreign population living in the West.

Exercise-Based Cardiac Rehabilitation: Secondary Data Analyses of Mortality and Working Capacity in Germany, 2010\u20132017

BackgroundExercise-based cardiac rehabilitation is safe and implemented in international cardiac rehabilitation guidelines. Evidence for long-term health effects is scarce and rare for health care service research.ObjectiveThe aim of this study is to evaluate the effectiveness of exercise-based phase III cardiac rehabilitation programs in improving mortality and working capacity outcomes.MethodsThe present analyses used claims data of the German pension fund from 2010 to 2017. Overall, 54,163 patients with coronary heart disease (ICD10 I20.–I25.) were included and followed up for exercise-based cardiac rehabilitation participation (mean 4.3 ± 1.9 years). All patients were categorized according to participation duration (long: ≥ 90 days, short: < 90 days, no). The effectiveness of exercise-based rehabilitation was analyzed by calculating adjusted hazard ratios for mortality and reduced working capacity in relation to program participation.ResultsOf all the cardiac patients, 57.6% received medical recommendations for exercise-based phase III rehabilitation, and 16.8% participated in this rehabilitation. In total, 1776 (3.3%) patients died during the study period, and 3050 (5.5%) received reduced earning capacity pensions. Mortality risk was nearly doubled for those who did not participate in exercise-based cardiac rehabilitation compared to those who participated for a long duration (HR 1.97, 95% CI 1.60–2.43) and 44% higher compared to a short participation (HR 1.44, 95% CI 1.03–2.01). Furthermore, the risk of reduced working capacity was higher for those who did not participate compared to those who participated for a short duration (HR 1.24, 95% CI 1.00–1.54).ConclusionExercise-based phase III cardiac rehabilitation is independently associated with reduced mortality and reduced loss in working capacity. Strong efforts should be made to increase participation rates to improve cardiac patients care.

Socioeconomic differences in mortality among 27 million economically active Germans: a cross-sectional analysis of the German Pension Fund data

ObjectivesTo assess disparities in mortality by socioeconomic status in Germany.Design and participantsWe analyse a large administrative dataset of the German Pension Fund (DRV), including 27 million person-years of exposure and...

Return to Work after Temporary Disability Pension

In Germany, there are no statistics available that reveal how many temporary disability pensioners return to work. The aim of this study was to analyse how many persons to whom a temporary disability pension was granted in 2006 returned to work. Their socio-demographic, health-related and vocational characteristics were examined. The scientific use file "Completed Rehabilitation 2006-2013 in the Course of Individual Pension Records" provided by the research data centre of the German Pension Fund was analysed. Return to Work was assumed if a person worked at least part-time for 183 to 365 days with not less than 8.50 euro/hour in one of the following seven years after being pensioned. The development of the cohort was assessed descriptively. Cox regression analyses were conducted to determine the influence of socio-demographic, health-related and vocational characteristics of the pensioners on their return to work. Between 2007 and 2013, 5.9% of the initial cohort (N=9.789) returned to work; 25% of these returned to work in all seven years. Between 2006 and 2014, 10.6% of the initial cohort died, 9.1% shifted to old-age pension and 1.4% were granted an unlimited disability pension. Regression analysis indicates that sociodemographic, health-related and vocational characteristics are associated with the probability of return to work: Disability pensioners aged between 18 and 39 years, with a somatic disease, who went through medical rehabilitation or were employed before the disability pension had the highest probability of return to work. The results show that only few persons with temporary disability pension returned to work. Therefore, it could be concluded that criteria for temporal limitations of pensions should be sharpened in order to reduce the amount of additional medical evaluations. On the other hand, new strategies to support pensioners' potential for return to work have to be considered.

Effect of Rehabilitation on the Delayed Entry into the Retirement due to Reduced Earning Capacity

Early retirements make up a large portion of indirect costs of illness caused by chronic back pain. Claims data from statutory health insurance and German Pension Fund provide the basis for analysis. Cox-Regression was performed for duration to early retirement, whereby beside sociodemographic and treatment characteristics, the effect of rehabilitation was considered. Early retirement started on average 7.1 month later through rehabilitation. Therefore, rehabilitants made € 8,432.60 higher payments to statutory health insurance and German Pension Fund per rehabilitant. Based on the total number of 21,262 early retirees with orthopedic indications, this can save € 180.7 million. The timing of the early retirement was also affected by age and sickness benefits in the previous month. Savings by avoiding entry into early retirement have not yet been taken into account in this model. Rehabilitants receive later pensions due to reduced ability, which allow for more contributions to statutory health insurance and German Pension Fund. This indicates that medical rehabilitation is an economic and effective treatment.

Prescription and Utilization of Sports Therapy Programs following Cardiac Rehabilitation 2006-2013

Physical exercise interventions are well accepted and widely used in cardiac rehabilitation programs. To ensure long-lasting effects on physical fitness and the maintenance of work ability a subsequent transfer to rehabilitation sport programs following cardiac rehabilitation is intended in a timely manner. The aim of the present study is to evaluate prescription and utilization rates of rehabilitation sport programs following cardiac rehabilitation. The present paper analyzes referral rates and the actual utilization of those programs in patients who had a cardiac rehabilitation in the years 2006-2013 using insurance data of the German pension fund. Overall, reductions in the prescription of rehabilitation sport programs can be observed. In 2013 55.7% (m) and 62.6% (w) of patients received a prescription for rehabilitation sport programs following cardiac rehabilitation. In contrast to declining prescription rates from 64.2 to 55.7% (m) and 68.0 to 62.6% (w) an increase in sports participation between 3-7% can be observed. Overall, participation rates between 9.7% and 22.5% (2012) seem not sufficient to promote long-term physical activity behavior change. Next to our evaluation, determinants and barriers for program participation should be investigated.

Inanspruchnahme einer Anschlussrehabilitation nach orthopädischer Operation – Beeinflusst die Fallschwere das Rehabilitationssetting (ambulant vs. stationär)?

The aim of this study was to examine which factors predict rehabilitation setting (inpatient vs. outpatient) after hospitalization in order to indicate the meaning of severity for access to a certain kind of rehabilitation. All patients with surgery for hip or knee (joint) endoprosthesis or disc surgery between 2005 and 2010 were selected for analysis from anonymized data from statutory health insurance (AOK Baden-Württemberg) and German Pension Fund (Bund as well as Baden-Württemberg). Logistic regression was performed for outpatient vs. inpatient rehabilitation. Patients from all surgery groups utilize more often inpatient rehabilitation, if they started treatment immediately after hospitalization than patients that start treatment after a period at home. With increasing age as well as comorbidities patients use more inpatient rehabilitation. The probability for inpatient rehabilitation decreased between 2005 and 2009. Beneath severity also context factors seem to be issues for the choice of inpatient or outpatient rehabilitation. For a demand-orientated access to a certain kind of rehabilitation, environmental conditions like support by family or accessibility to therapeutic, nursing or medical assistance and medical parameters like severity should be weighed against each other.

Plädoyer für einen „Rentenfonds Deutschland“

The German government has recently adopted a reform package for a statutory pension insurance plan to ensure that the pension level will not fall below 48 % and that the contribution rate will not exceed 20 % through 2025. In addition, there are planned improvements in “Mütterrente” (a pension for mothers), assistance for people with reduced earning capacity and those who do not earn enough. The total extra cost of these measures is estimated at approximately 32 billion euro, financed by funds from the statutory pension system and by increased federal subsidies. It is not yet known pay-as-you-go pension system will be reformed after 2025. The author suggests establishing a “German Pension Fund” as a capital backed fund with a highly diversified investment portfolio. A German sovereign wealth fund of this kind could make an important contribution to greater intergenerational equity. Financing could be provided by, for example, retaining part of the solidarity surcharge on German income tax rather than abolishing it entirely, as is currently envisaged.

Health Economic Effects of Rehabilitation for Chronic Back Pain - An Observational Study with Combined Secondary Data from Statutory Health Insurance and German Pension Fund

Chronic back pain is the most common indication in medical rehabilitation. Numerous studies hint on positive effects of rehabilitation on health state. However, there is no evidence about the effectiveness of rehabilitation due to the lack of a valid comparison group. Based on combined secondary data from German Pension Fund and statutory health insurance, a comparison group of insured persons was identified by their typical patient career that did not apply for rehabilitation for unclear reasons. Effectiveness was measured by direct and indirect costs of back pain between rehabilitants and non-rehabilitants. Costs of rehabilitation split in 2.742 € direct costs and 2.597 € indirect costs. In the 2 years following rehabilitation, rehabilitants were hospitalized less frequent and caused less indirect costs due to disability. Therefore, the benefit of rehabilitation was 727 € in the first year after rehabilitation and additional 37 € in the subsequent year. Rehabilitation for chronic back pain contributes to maintain the ability to work. Moreover, rehabilitation reduces duration of disability and healthcare utilization, hence direct and indirect costs of illness are lowered compared to a treatment without rehabilitation. Effects of rehabilitation by avoidance and delay of retirement are not yet recorded.

Fostering needs assessment and access to medical rehabilitation for patients with chronic disease and endangered work ability: protocol of a multilevel evaluation on the effectiveness and efficacy of a CME intervention for general practitioners

BackgroundStudies show that endangered work ability (EWA) can be maintained or restored through medical rehabilitation (MR). For patients, general practitioners (GP) represent an important point of access to MR in outpatient care. However, many different barriers and shortcomings hinder GPs in both timely detection of the need for MR and the recognition of its potentials for their EWA-patients. These are necessary if GPs are to adequately inform patients about MR options and successfully support applications for MR. This study describes the evaluation of a continuing medical education (CME) module designed to improve rehabilitation-related practical performance of GPs regarding a) subjective satisfaction of GPs with the CME module, b) stability of attitudes and knowledge over time regarding rehabilitation, and c) subjective and objective changes in MR-related competencies needed to support MR applications.MethodsThis study is an open, non-randomised, pre-post-intervention study. The intervention involves a CME module for GPs (n = 1365) in the German state of Saxony-Anhalt on the topic of medical rehabilitation in connection with the federal German pension fund (Deutsche Rentenversicherung). The module will be initially held as regularly scheduled meetings in moderated GP quality circles (QC), and then offered as a written self-study unit. At the end it will be evaluated by the GPs. The study’s primary focus is on the organizational practice as measured by the number of approved MR applications supported by medical reports submitted by the participating GPs in the 6 months before and 6 months after the CME module. Other study aims involve measuring self-perceived competencies of GPs, as well as their attitudes towards and knowledge of rehabilitation (both upon completing the CME and 6 months later). In addition, the level of satisfaction with the CME module will be analysed among participating GPs and QC moderators (as CME facilitators).DiscussionImplementing targeted CME on complex topics such as those involving barriers is possible, even promising, when using QCs and their moderators. Of particular importance is how aware moderating physicians are of the relevance of MR need detection and access.Ethics and disseminationThe ethics committee of the Martin-Luther-Universität Halle-Wittenberg has registered this study under the number 2014–13. The study will be reported on in peer-reviewed journals and at national and international conferences. The results will be available to current and future initiatives aiming to improve detection of MR need and making MR accessible to EWEC patients needing such support to minimize the effects of chronic disease on their livess.Trial registration numberGerman Clinical Trials Register (ID number DRKS00006188) and WHO International Clinical Trials Registry Platform, Universal Trial Number (UTN) U1111–1158-8334.

Associations of the Employment Status during the First 2 Years Following Medical Rehabilitation and Long Term Occupational Trajectories: Implications for Outcome Measurement

Study Objectives: The aim was to investigate the predictive value of the employment status measured in the 6th, 12th, 18th and 24th month after medical rehabilitation for long-term employment trajectories during 4 years. Methods: A retrospective study was conducted based on a 20%-sample of all patients receiving inpatient rehabilitation funded by the German pension fund. Patients aged <62 years who were treated due to musculoskeletal, cardiovascular or psychosomatic disorders during the years 2002-2005 were included and followed for 4 consecutive years. The predictive value of the employment status in 4 predefined months after discharge (6th, 12th, 18th and 24th month), for the total number of months in employment in 4 years following rehabilitative treatment was analyzed using multiple linear regression. Per time point, separate regression analyses were conducted, including the employment status (employed vs. unemployed) at the respective point in time as explanatory variable, besides a standard set of additional prognostic variables. Results: A total of 252 591 patients were eligible for study inclusion. The level of explained variance of the regression models increased with the point in time used to measure the employment status, included as explanatory variable. Overall the R²-measure increased by 30% from the regression model that included the employment status in the 6th month (R²=0.60) to the model that included the work status in the 24th month (R²=0.78). Conclusion: The degree of accuracy in the prognosis of long-term employment biographies increases with the point in time used to measure employment in the first 2 years following rehabilitation. These findings should be taken into consideration for the predefinition of time points used to measure the employment status in future studies.

The Impact of Psychological Comorbidities Concerning a Pension for Reduced Earning Capacity after Medical Rehabilitation

Background: The role of psychological comorbidities as a risk factor associated with a further chronification in low back pain is evident. In this paper we explore, whether psychological comorbidities recorded in the discharge letters have a time-stable and from other risk factors independent impact on a pension for reduced earning capacity. Methods: A sample of 10% is drawn from a routine data set provided by the German Pension Fund. Several risk factors are defined and presented descriptively. The survival analysis will be accomplished by cox regressions. Results: Younger patients (≤ 55 years) with at least one comorbid mental disorder have a 1.93 times higher chance of getting a pension for reduced earning capacity in the follow-up period. The influence is time stable and independent from other risk factors. Conclusion: A screening of psychological symptoms with a risk stratified therapy could increase the effectiveness.

Promoting physical activity and health literacy: study protocol for a longitudinal, mixed methods evaluation of a cross-provider workplace-related intervention in Germany (The AtRisk study).

BackgroundPhysical activity and health literacy are topics of utmost importance in the prevention of chronic diseases. The present article describes the study protocol for evaluating a cross-provider workplace-related intervention promoting physical activity and health literacy.MethodsThe RE-AIM Framework will be the conceptual framework of the AtRisk study. A controlled natural experiment and a qualitative study will be conducted. The cross-provider intervention is based on the cooperation of the German Pension Fund Rhineland and cooperating German Statutory Health Insurances. It combines two components: a behavior-oriented lifestyle intervention and the assignment of a health coach. The single-provider intervention only includes the behavior-oriented lifestyle intervention.The quantitative study (natural experiment) encompasses three measuring points (T0 = start of the behavior-oriented lifestyle intervention (baseline); T1 = end of the behavior-oriented lifestyle intervention (16 weeks); T2 = 6 month follow-up) and will compare the effectiveness of the cross-provider workplace-related intervention compared with the single provider intervention. Participants are employees with health related risk factors. ANCOVA will be used to evaluate the effect of the intervention on the outcome variables leisure time physical (primary outcome) activity and health literacy (secondary outcome). The qualitative study comprises semi-structured interviews, systematic field notes of stakeholder meetings and document analyses.DiscussionThe AtRisk study will contribute towards the claim for cross-provider interventions and workplace-related approaches described in the new Preventive Health Care Act. The results of this study will inform providers, payers and policy makers about the effectiveness of a cross-provider workplace-related lifestyle intervention compared to a single-provider intervention. Beyond, the study will identify challenges for implementing cross-provider preventive interventions. With respect to the sustainability of preventive interventions the AtRisk study will give insight in the expectations and needs on health coaching from the perspective of different stakeholders.Trial registrationDRKS00010693.

The Blended Approach to Real Estate Allocations: Performance Implications of Combining an Exposure to German Spezialfonds with Global Listed Real Estate Securities

This paper seeks to increase the understanding of the performance implications for investors who choose to combine an unlisted real estate portfolio (in this case German Spezialfonds) with a (global) listed real estate element. We call this a “blended” approach to real estate allocations. For the avoidance of doubt, in this paper we are dealing purely with real estate equity (listed and unlisted) allocations, and do not incorporate real estate debt (listed or unlisted) or direct property into the process. A previous paper (Moss and Farrelly 2014) showed the benefits of the blended approach as it applied to UK Defined Contribution Pension Schemes. The catalyst for this paper has been the recent attention focused on German pension fund allocations, which have a relatively low (real estate) equity content, and a high bond content. We have used the MSCI Spezialfonds Index as a proxy for domestic German institutional real estate allocations, and the EPRA Global Developed Index as a proxy for a global listed real estate allocation. We also examine whether a rules based trading strategy, in this case Trend Following, can improve the risk adjusted returns above those of a simple buy and hold strategy for our sample period 2004-2015. Our findings are that by blending a 30% global listed portfolio with a 70% allocation (as opposed to a typical 100% weighting) to Spezialfonds, the real estate allocation returns increase from 2.88% p.a. to 5.42% pa. Volatility increases, but only to 6.53%., but there is a noticeable impact on maximum drawdown which increases to 19.4%. By using a Trend Following strategy raw returns are improved from 2.88% to 6.94% p.a. , The Sharpe Ratio increases from 1.05 to 1.49 and the Maximum Drawdown ratio is now only 1.83% compared to 19.4% using a buy and hold strategy . Finally, adding this (9%) real estate allocation to a mixed asset portfolio allocation typical for German pension funds there is an improvement in both the raw return (from 7.66% to 8.28%) and the Sharpe Ratio (from 0.91 to 0.98).

Use of Mental Health Care Services by People with Depression in Germany: a Secondary Data Analysis

Introduction According toepidemiologic studies, depression is one of the most frequentmental disorders in Germany. Based on the secondary data of three statutoryhealth insurers and the German Pension Fund, the utilization of mental healthcare services of people with depression was analyzed. Objectives The analysesdescribe the utilization of in- and outpatient mental health care services ofpeople with depression by different disciplines and utilization patterns overtime (pathways of care). Aim The main aim was to analyze mental healthcareutilization of people with depression in Germany in 2005–2007 in order toidentify areas of potential optimization of mental health care. Methods Secondary data of three statutory health insurancecompanies and of the German Pension Funds of the years 2005-2007 were used forthese analyses. The analyses are based on 1,435,133 persons with at least onediagnosis of a depression (F32/F33) in 2005-2007. Results The majority (73 %) of depression diagnoses wereclassified as ‘‘unspecified’’. For both inpatients and outpatients, aconsiderable proportion of care for mental illnesses was provided by primarycare physicians/other specialists in somatic medicine. Analyses of the pathwaysof care of people with severe depression revealed low levels of collaborationbetween primary and specialized care as well as outpatient and inpatienttreatment. Conclusions Setting aside boundaries between different disciplines and sectors, theuse of secondary data can, despite its limitations, contributes to thedetection of under- and overdiagnosis, mistaken allocation, and intersectoralinterface problems.