System In Switzerland Research Articles

Confidence in Alternative Dispute Resolution: Experience from Switzerland

Alternative Dispute Resolution plays a crucial role in the justice system of Switzerland. With the unified Swiss Code of Civil Procedure, it is required that each litigation session shall be preceded by an attempt at conciliation before a conciliation authority. However, there has been little research on conciliation authorities and the public's perception of the authorities. This paper looks at public confidence in conciliation authorities and provides results of a survey conducted with more than 3,400 participants. This study found that public confidence in Swiss conciliation authorities is generally high, exceeds the ratings for confidence in cantonal governments and parliaments, but is lower than confidence in courts. Since the institutional models of the conciliation authorities (meaning the organization of the authorities and the selection of the conciliators) differ widely between the 26 Swiss cantons, the influence of the institutional models on public confidence is analyzed. Contrary to assumptions based on New Institutional-ism approaches, this study reports that the institutional models do not impact public confidence. Also, the relationship between a participation in an election of justices of the peace or conciliators and public confidence in these authorities is found to be at most very limited (and negative). Similar to common findings on courts, the results show that general contacts with conciliation authorities decrease public confidence in these institutions whereas a positive experience with a conciliation authority leads to more confidence. The Study was completed as part of the research project 'Basic Research into Court Management in Switzerland', supported by the Swiss National Science Foundation (SNSF). Christof Schwenkel is a PhD student at the University of Lucerne and a research associate and project manager at Interface Policy Studies. A first version of this article was presented at the 2013 European Group for Public Administration (EGPA) Annual Conference in Edinburgh.

Column studies to assess the effects of climate variables on redox processes during riverbank filtration

Riverbank filtration is an established technique used world-wide to produce clean drinking water in a reliable and cost-efficient way. This practice is, however, facing new challenges posed by climate change, as already observed during past heat waves with the local occurrence of anoxic conditions. In this study we investigated the effect of direct (temperature) and indirect (dissolved organic matter (DOM) concentration and composition, flow rate) climate change variables on redox processes (aerobic respiration, denitrification and Mn(III/IV)/Fe(III) reduction) by means of column experiments. Natural river water, modified river water and river water mixed with treated wastewater effluent were used as feed waters for the columns filled with natural sand from a river-infiltration system in Switzerland. Biodegradable dissolved organic matter was mainly removed immediately at the column inlet and particulate organic matter (POM) associated with the natural sand was the main electron donor for aerobic respiration throughout the column. Low infiltration rates (≤0.01 m/h) enhanced the oxygen consumption leading to anoxic conditions. DOM consumption did not seem to be sensitive to temperature, although oxygen consumption (i.e., associated with POM degradation) showed a strong temperature dependence with an activation energy of ∼70 kJmol−1. Anoxic conditions developed at 30 °C with partial denitrification and formation of nitrite and ammonium. In absence of oxygen and nitrate, Mn(II) was mobilized at 20 °C, highlighting the importance of nitrate acting as a redox buffer under anoxic conditions preventing the reductive dissolution of Mn(III/IV)(hydr)oxides. Reductive dissolution of Fe(III)(hydr)oxides was not observed under these conditions.

Training participation of internationalized firms: establishment-level evidence for Switzerland

BackgroundSwitzerland is host to many international companies, and a large share of Swiss firms is exporting goods and services abroad. While the vocational education and training (VET) system in Switzerland has a long tradition, there is a paucity of studies investigating the effects of the ongoing internationalization on the training participation of internationalized firms.MethodsThe empirical analysis uses representative cross-sectional survey data for Switzerland to estimate a firm’s training decision in 2009. I apply multivariate regression techniques to account for observable differences between domestic and internationalized firms.ResultsThe results show that small and internationalized firms with less than 50 employees have a significantly lower training probability than comparable domestic firms, while this is not the case for larger firms – mainly because internationalized firms are too specialized and provide internal training to workers without a VET degree. Relating the results to the theory of the varieties of capitalism, I find no statistically significant differences in the training participation of similar-sized firms with headquarters in typical liberal market economies (United States, United Kingdom) and a coordinated market economy (Germany), stressing the importance of other factors such as location, sector, firm size, and the local labor market environment.ConclusionWhile large internationalized firms show a similar training participation as domestic firms, a large fraction of small and internationalized firms does not offer apprenticeships even though they are aware of a potentially suitable training occupation. Thus policies promoting alternative forms of training, such as training networks that facilitate access to apprenticeship training for small and specialized firms, may possibly increase the future training participation of internationalized firms.JEL-codesJ24; M51; M53

Lameness and foot lesions in Swiss dairy cows: I. Prevalence

Prevalences of foot lesions and lameness were recorded in 1'449 Swiss dairy cows during routine claw-trimming on 78 farms from June 2010 until February 2011. Lameness was present in 14.8 % of cows and on 80.8 % of investigated farms. Highest prevalences were seen for widened white line (80.7 %/100 %), signalling foot lesion (65.6 %/98.7 %), heel-horn erosion (34.2 %/88.5 %), digital dermatitis complex (29.1 %/73.1 %), severe hemorrhages (27.9 %/87.2 %), and Rusterholz' sole ulcers (11.5 %/74.4 %) at cow and herd level, respectively. Lower prevalences were found for subclinical laminitis (5.4 %/47.4 %), chronic laminitis (3.3 %/25.6 %), white line disease (4.7 %/42.3 %), double soles (2.6 %/33.3 %), interdigital hyperplasia (3.1 %/33.3 %), sole ulcers (0.4 %/6.4 %), toe infections caused by faulty claw-trimming (3.9 %/39.7 %) and by injury (0.1 %/2.6 %), deep lacerations (0.4 %/6.4 %), and interdigital phlegmona (0.1 %/1.3 %). Lameness and foot lesions were shown to represent important health problems of dairy cows under the conditions of the typical grass-based production system in Switzerland. Digital dermatitis has developed to the most relevant foot disease with a high impact on welfare of Swiss dairy cows within the past 10 years.

Improving the measurement of urban sprawl: Weighted Urban Proliferation (WUP) and its application to Switzerland

Growing urban sprawl is a serious concern worldwide for a number of environmental and economic reasons and is a major challenge on the way to sustainable land use. To address this increasing problem, there is an urgent need for quantitative measurement. Every meaningful method to measure the degree of urban sprawl needs to be based on a clear definition of “urban sprawl” disentangling causes and consequences of urban sprawl from the phenomenon of urban sprawl itself, as urban sprawl has differing causes and consequences in different regions and regulatory contexts. Weighted Urban Proliferation (WUP) – the novel method presented in this paper – is based on the following definition of urban sprawl: the more area built over in a given landscape (amount of built-up area) and the more dispersed this built-up area in the landscape (spatial configuration), and the higher the uptake of built-up area per inhabitant or job (lower utilization intensity in the built-up area), the higher the degree of urban sprawl. However, there is a lack of reliable measures of urban sprawl that integrate these three dimensions in a single metric. Therefore, these three independent dimensions need to be combined according to the qualitative assessment of sprawl to create a suitable metric – which is exactly what the WUP metric does using two weighting functions.Switzerland serves as an example of applying this method to examine the current state, for comparisons among regions, for historical analysis, and for assessing planning scenarios. The degree of urban sprawl in Switzerland increased by 155% between 1935 and 2002, and without rigorous measures, scenarios of future urban sprawl show that it is likely to further increase by more than 50% until 2050. Examples from parts of Switzerland demonstrate that sprawl can be reduced. As a consequence of intense public discussion, the Swiss Spatial Planning Act was revised in 2013 to make it tighter. We conclude that the new method is more suitable than previous methods to quantify the indicator “urban sprawl” in monitoring systems, e.g., it has now been implemented in monitoring systems in Switzerland. The new WUP method is highly suitable for performance control of limits to urban sprawl once they are implemented and for application to other countries around the globe.

The impact of federalism on the healthcare system in terms of efficiency, equity, and cost containment: the case of Switzerland.

According to the economic theory of federalism (Oates 1999), a decentralized decision to collectively fund and supply the quantity and quality of public services will increase economic welfare as long as three conditions are fulfilled: preferences and production costs of the different local constituencies are heterogeneous; local governments are better informed than the central agency because of their proximity to the citizens; and the competition between local governments exerts a significant impact on the performance of the local administration and on the ability of public agencies to implement policy innovation. Federalism also presents some negative aspects, including the opportunity costs of decentralization, which materialize in terms of unexploited economies of scale; the emergence of spillover effects among jurisdictions; and the risk of cost-shifting exercises from one layer of the government to the other. Finally, competition between fiscal regimes can affect the level of equity. The literature considers fiscal federalism as a mechanism for controlling the size of the public sector and for constraining the development of redistributive measures. The present paper reviews the impact that federalism has on the efficiency, equity, and cost containment of the healthcare system in Switzerland, a country with a strongly decentralized political system that is based on federalism and the institutions of direct democracy, a liberal economic culture, and a well-developed tradition of mutualism and social security (generous social expenditure and welfare system). By analyzing the empirical evidence available for Switzerland, we expect to draw some general policy lessons that might also be useful for other countries.

Questionnaire-based study to assess the association between management practices and mastitis within tie-stall and free-stall dairy housing systems in Switzerland

BackgroundProphylactic measures are key components of dairy herd mastitis control programs, but some are only relevant in specific housing systems. To assess the association between management practices and mastitis incidence, data collected in 2011 by a survey among 979 randomly selected Swiss dairy farms, and information from the regular test day recordings from 680 of these farms was analyzed.ResultsThe median incidence of farmer-reported clinical mastitis (ICM) was 11.6 (mean 14.7) cases per 100 cows per year. The median annual proportion of milk samples with a composite somatic cell count (PSCC) above 200,000 cells/ml was 16.1 (mean 17.3) %. A multivariable negative binomial regression model was fitted for each of the mastitis indicators for farms with tie-stall and free-stall housing systems separately to study the effect of other (than housing system) management practices on the ICM and PSCC events (above 200,000 cells/ml). The results differed substantially by housing system and outcome. In tie-stall systems, clinical mastitis incidence was mainly affected by region (mountainous production zone; incidence rate ratio (IRR) = 0.73), the dairy herd replacement system (1.27) and farmers age (0.81). The proportion of high SCC was mainly associated with dry cow udder controls (IRR = 0.67), clean bedding material at calving (IRR = 1.72), using total merit values to select bulls (IRR = 1.57) and body condition scoring (IRR = 0.74). In free-stall systems, the IRR for clinical mastitis was mainly associated with stall climate/temperature (IRR = 1.65), comfort mats as resting surface (IRR = 0.75) and when no feed analysis was carried out (IRR = 1.18). The proportion of high SSC was only associated with hand and arm cleaning after calving (IRR = 0.81) and beef producing value to select bulls (IRR = 0.66).ConclusionsThere were substantial differences in identified risk factors in the four models. Some of the factors were in agreement with the reported literature while others were not. This highlights the multifactorial nature of the disease and the differences in the risks for both mastitis manifestations. Attempting to understand these multifactorial associations for mastitis within larger management groups continues to play an important role in mastitis control programs.

Improving the organ donor card system in Switzerland

This paper analyses the current organ donor card system in Switzerland and identifies five problems that may be partially responsible for the country's low deceased organ donation rates. There are two minor issues concerning the process of obtaining a donor card: the Swisstransplant website understates the prospective benefits of donation, and the ease with which donor cards can be obtained raises questions regarding whether any consent to donation provided is truly informed. Furthermore, there are two major practical problems that might affect those who carry an organ donor card: the lack of a central donor registry increases the likelihood that donors' wishes will be "lost", and there is a high probability that family members will veto organ donation. The fact that these two practical problems are not mentioned to potential donors by Swisstransplant constitutes the fifth problem. Donation rates would probably improve if more accurate information about the benefits of donation were provided to potential donors, a central donor registry were created, and families were not permitted to veto donation from those on the registry.

Quantifying costs and lengths of urban drainage systems with a simple static sewer infrastructure model

A generic model is introduced that is capable of quantitatively representing the combined sewer infrastructure of a settlement. It consists of a catchment area module, which calculates the length and size distribution of the needed sewer pipes on the basis of rain, housing densities and area size. These results are fed into the sewer construction costs module in order to estimate the combined sewer costs of the entire catchment area. The model could be successfully fitted to existing Swiss sewer systems, indicating that it can emulate their principal characteristics. It could also identify fundamental differences in sewer designs in cities with historic roots. The results confirm that there are economies of scale for combined sewer systems in Switzerland. The modelling approach proved to be an effective tool for understanding the factors underlying the cost structure for water network infrastructures.

School tracking and educational inequality: a comparison of 12 education systems in Switzerland

Using data from the super-sample of the ‘PISA Suisse’ 2003 assessment, this article examines the relationship between the characteristics of education systems (made up of homogeneous or heterogeneous tracks) and their consequences in terms of effectiveness and equity. Our results indicate that it is not so much the official structure of tracks as the ways in which tracking is really organised – and, in particular, the degree of segregation that tracking methods involve – which make it possible to explain inequalities among students. They also show that some education systems are more inegalitarian than others and that the factors leading to inequalities can vary significantly from one Swiss canton to another. Finally, through multilevel analyses, we demonstrate that when the individual and aggregate characteristics of students are taken into account, the type of track a student attends is of only limited significance for explaining inequalities, which suggests that the effects of tracking are in fact linked to the nature of the population educated in the tracks.

Cooperative Management of a Traditional Irrigation System in the Swiss Alps

Traditional channel irrigation systems in Switzerland are managed on a community basis and have high cultural, touristic and ecological values. However, many irrigation communities disappeared in the last decades. This paper analyzes the factors contributing to the continuation of a still existent irrigation community. Our analysis thus provides insights into how to avoid further losses of these unique agricultural systems and to preserve the associated benefits. Based on hypotheses derived from game theoretical analysis, a survey was conducted in an irrigation community located in the canton of Valais. Our results show that the motivation of community members to remain in the traditional system is not a financial one. In contrast, factors such as long-term perspectives, system knowledge, communication and the institutional setting seem to be the basis for the continuation of the analyzed irrigation community. For policy makers, this example shows that the creation of institutions that enable self-governance, communication and knowledge transfer should be considered in this field of rural and agricultural policy making.

The review of planning practice in brownfield regeneration: Some European experiences

The research subject is the analysis of the possible ways to achieve stakeholder compliance in the brownfield regeneration process. In a narrow sense, the treatment of brownfield sites within different planning systems is considered. Each of the selected planning systems is described through the institutional structure as well as the regulative framework. The aim of the paper is to show urban planning mechanisms that are used for the establishment of collaboration between different stakeholders involved in brownfield regeneration. In the very beginning, a brief history of spatial development is given. A special emphasis is on the current trends in the brownfield regeneration. The central part of the paper deals with the overview of selected examples in terms of brownfield regeneration. It is followed by the overview of the institutional aspect within the planning system in Switzerland and Austria. The determination of the responsible institutions for the brownfield regeneration process is of particular importance. Also, it is important to show the basic documents dealing with the above-mentioned topics. However, the focus of research concerns the collaborative procedures to achieve the successful regeneration of brownfields. Those results stem from the analysis of the brownfield sites examples. Namely, the first example relates to the regeneration of wood-industry complex in the Swiss town of Solothurn, while the second case indicates the regeneration of cable and wire factory in Vienna. The final section of the paper systemizes the experiences from the developed countries which provide a possible formulation of general brownfield regeneration model to be applied within different contexts.

The Tertiary Education Systems in Switzerland

The Tertiary Education Systems in Switzerland

An economic assessment of drought effects on three grassland systems in Switzerland

This paper analyzes the economic impacts of summer drought on Swiss grassland production. We combine field trial data from drought experiments in three different grasslands in Switzerland with site-specific information on economic costs and benefits. The analysis focuses on the economic implications of drought effects on grassland yields as well as grassland composition. In agreement with earlier studies, we found rather heterogeneous yield effects of drought on Swiss grassland systems, with significantly reduced yields as a response to drought at the lowland and sub-alpine sites, but increased yields at the wetter pre-alpine site. Relative yield losses were highest at the sub-alpine site (with annual yield losses of up to 37 %). However, because income from grassland production at extensive sites relies to a large extent on ecological direct payments, even large yield losses had only limited implications in terms of relative profit reductions. In contrast, negative drought impacts at the most productive, intensively managed lowland site were dominant, with average annual drought-induced profit margin reductions of about 28 %. This is furthermore emphasized if analyzing the farm level perspective of drought impacts. Combining site-specific effects at the farm level, we found that in particular farms with high shares of lowland grassland sites suffer from summer droughts in terms of farm-level fodder production and profit margins. Moreover, our results showed that the higher competitiveness of weeds (broad-leaved dock) under drought conditions will require increasing attention on weed control measures in future grassland production systems. Taking into account that the risk of drought occurrence is expected to increase in the coming years, additional instruments to cope with drought risks in fodder production and finally farmers’ income have to be developed.

Environomic optimal configurations of geothermal energy conversion systems: Application to the future construction of Enhanced Geothermal Systems in Switzerland

The development of Enhanced Geothermal Systems (EGS) for the cogeneration of electricity and district heating is expected to be important in the future. The criteria to be accounted for in the energy conversion system design are the economic profitability, the thermodynamic efficiency in the usage of the resource, and the generated life-cycle environmental impacts, which are as well a key point for the public acceptance of geothermal energy. This paper presents a systematic methodology for the optimal design and configuration of geothermal systems considering environomic criteria. Process design and process integration techniques are used in combination with Life Cycle Assessment (LCA) and multi-objective optimization techniques, using a multi-period strategy to account for the seasonal variations in the district heating demand. It is illustrated by an application to the future EGS construction for cogeneration in the context of Switzerland. Different conversion cycles are considered: single and double-flash systems, organic Rankine cycles (ORC), and Kalina cycles. The optimal configuration is determined at each construction depth for the EGS from 3000 down to 10,000 m and at each district heating network installed capacity from 0 to 60 MWth. Results show that in the shallowest range of depths (3500–6000 m), the optimal configurations for all considered performance indicators are EGS between 5500 and 6000 m with a Kalina cycle for cogeneration, and a district heating network with an installed capacity between 20 and 35 MWth. In the deepest range (7500–9500 m), when compared with the single electricity production, the cogeneration of district heating is less favorable from an economic and exergetic perspective (11% and 17% of relative penalty, respectively, for a district heating network with an installed capacity of 60 MWth) but more favorable in terms of environmental performance (37% of relative improvement for avoided CO2 emissions).

Current status and future challenges of deep brain stimulation in Switzerland

Deep brain stimulation (DBS) has become a standard therapy for some forms of severe movement disorders and is investigated for other neurological and psychiatric disorders, although many scientific, clinical and ethical issues are still open. We analyse how the Swiss DBS community addresses these problematic issues and future challenges. We have performed a survey among Swiss DBS centres and a Delphi study with representatives of all centres and further stakeholders related to the topic. The current DBS infrastructure in Switzerland consists of seven facilities. About 850-1,050 patients have received a DBS system in Switzerland for various indications since its advent in 1976. Critical issues like patient selection and dealing with side effects are in accordance with international standards. There are indications of a conservative referral practice in Switzerland for DBS interventions, but the data available do not allow verifying or refuting this point. Issues to investigate further are whether or not there is an unmet medical need with respect to DBS, long-term medical and psychosocial sequelae of the intervention, conditions for enhancing the (research) collaboration of Swiss DBS centers, and the effect of the recent decision to reduce the number of DBS centres to 4 (resp. possibly 3) on the potential of this therapeutic approach.

Sustainability assessment of GM crops in a Swiss agricultural context

The aim of this study was to provide an ex ante assessment of the sustainability of genetically modified (GM) crops under the agricultural conditions prevailing in Switzerland. The study addressed the gaps in our knowledge relating to (1) the agronomic risks/benefits in production systems under Swiss conditions (at field and rotation/orchard level), (2) the economic and socio-economic impacts associated with altered farming systems, and (3) the agro-ecological risks/benefits of GM crops (at field and rotation/orchard level). The study was based on an inventory of GM crops and traits which may be available in the next decade, and on realistic scenarios of novel agricultural practices associated with the use of GM crops in conventional, integrated, and organic farming systems in Switzerland. The technology impact assessment was conducted using an adapted version of the matrix for “comparative assessment of risks and benefits for novel agricultural systems” developed for the UK. Parameter settings were based on information from literature sources and expert workshops. In a tiered approach, sustainability criteria were defined, an inventory of potentially available, suitable GM crops was drawn up, and scenarios of baseline and novel farming systems with GM crops were developed and subsequently submitted to economic, socio-economic, and agro-ecological assessments. The project had several system boundaries, which influenced the outcomes. It was limited to the main agricultural crops used for food and feed production and focused on traits that are relevant at the field level and are likely to be commercially available within a decade from the start of the project. The study assumed that there would be no statutory restrictions on growing GM crops in all farming systems and that they would be eligible for direct payments in the same way as non-GM crops. Costs for co-existence measures were explicitly excluded and it was assumed that GM foods could be marketed in the same way as non-GM foods at equal farm gate prices. The following model GM crops were selected for this study: (1) GM maize varieties with herbicide tolerance (HT), and with resistance to the European corn borer (Ostrinia nubilalis) and the corn rootworm (Diabrotica virgifera); (2) HT wheat; (3) GM potato varieties with resistance to late blight (Phytophthora infestans), to the nematode Globodera spp., and to the Colorado beetle (Leptinotarsa decemlineata); (4) HT sugar beet with resistance to “rhizomania” (beet necrotic yellow vein virus; BNYVV); (5) apples with traditionally bred or GM resistance to scab (Venturia inaequalis), and GM apples with stacked resistance to scab and fire blight (Erwinia amylovora). Scenarios for arable rotations and apple orchards were developed on the basis of the model crops selected. The impact assessments were conducted for the entire model rotations/orchards in order to explore cumulative effects as well as effects that depend on the farming systems (organic, integrated, and conventional). In arable cropping systems, herbicide tolerance had the most significant impact on agronomic practices in integrated and conventional farming systems. HT crops enable altered soil and weed management strategies. While no-till soil management benefited soil conservation, the highly efficient weed control reduced biodiversity. These effects accumulated over time due to the high proportion of HT crops in the integrated and conventional model rotations. In organic production systems, the effects were less pronounced, mainly due to non-use of herbicides. Traits affecting resistance to pests and diseases had a minor impact on the overall performance of the systems, mainly due to the availability of alternative crop protection tools or traditionally bred varieties. The use of GM crops had only a minor effect on the overall profitability of the arable crop rotations. In apple production systems, scab and fire blight resistance had a positive impact on natural resources as well as on local ecology due to the reduced need for spray passages and pesticide use. In integrated apple production, disease resistance increased profitability slightly, whereas in the organic scenario, both scab and fire blight resistance increased the profitability of the systems substantially. In conclusion, the ecological and socio-economic impacts identified in this study were highly context sensitive and were associated mainly with altered production systems rather than with the GM crops per se.

Validation of the NGM SElect™ kit

The Swiss national database was launched August 2000 based on the 10 SGM Plus loci. With the aim of addressing the needs of the next-generation European STR genotyping systems in Switzerland, we validated the NGM SElect™ kit. In this study, we present the results of forensic validation studies including the following aspects: sensitivity, heterozygote peak height ratio calculations, performance with simulated PCR inhibition, proficiency tests and Swiss population data.

Buoying Health By Building Communities

From the Editor-In-Chief Health AffairsVol. 30, No. 11: Linking Community Development & Health Buoying Health By Building CommunitiesSusan DentzerPUBLISHED:November 2011Free Accesshttps://doi.org/10.1377/hlthaff.2011.1174AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSLow incomePaymentBundled chargesPublic healthAccess to careCommunity health centers Last month’s Health Affairs explored the social and economic determinants of health that drive disparities, such as the places in which people live. This month we expand on that topic in articles that discuss emerging synergies among community development, health care, and public health. The cluster results from the combined efforts of the Robert Wood Johnson Foundation and the US Federal Reserve to advance understanding that “safe, vibrant neighborhoods are vital to health,” as the Fed’s David Erickson observes. For years, there was little interaction between the public health and health care sectors and the nation’s community development “industry”—the network of nonprofit and governmental agencies, real estate developers, and financial institutions that marshal public subsidies and other financing to transform poor neighborhoods.Collaboration GapAs David Williams notes, the foundation became acutely aware of the gap through its sponsorship of the Commission to Build a Healthier America, which the foundation convened in 2008 and of which Williams served as staff director. The Fed’s awareness stems from its congressional mandate to achieve strong, low-inflation economic growth and to help low-income communities become full partners in that process.So, as the foundation’s Risa Lavizzo-Mourey and Sandra Braunstein of the Fed write, both sectors are now focused on what they might achieve together. Health care providers understand that they can make more headway against chronic disease if residents of a local housing complex have access to safe parks and healthier food. Community developers understand that beyond creating low-income housing, they should also invest in these amenities and even construction or expansion of community health centers.Budding PartnershipsArticles in this issue profile encouraging examples of partnerships. Working largely through the nation’s network of so-called community development financial institutions, the federal Healthy Food Financing Initiative now channels $500 million annually into creation of grocery stores selling healthier food in low-income neighborhoods. Ronda Kotelchuck and colleagues highlight efforts by private investors and lenders to finance expansion of federally qualified community health centers in California and midwestern states.As Williams observes, it will be critical to build the evidence over time that these partnerships truly advance health outcomes and deliver on the promise of healthier communities. Meanwhile, new tools can help focus attention and frame decision making on the health-promoting potential of community investment measures: so-called health impact assessments, of which more than 100 have been completed or are under way nationwide. A recent assessment in Nashville, Tennessee, for example, identified health benefits to be gained from greater use of mass transit—largely stemming from the fact that walking to and from the light rail station or bus stop can add up to thirty minutes or more of moderate physical activity daily.We thank the Robert Wood Johnson Foundation for the generous support that allowed us to publish this article cluster—and welcome a new stable of authors from the Federal Reserve.Payment InnovationTurning to matters more commonly addressed in our pages, we also focus this month on payment reforms to drive more efficient health care. Various articles invoke the old adage about bridal attire at weddings—something old, something new, something borrowed, and something blue.Uwe Reinhardt explores an approach simultaneously “old” and “borrowed”—all-payer price negotiations, which have long characterized health financing systems in Switzerland and Germany and, closer to home, Maryland’s system of paying hospitals. He asks again whether such a system might not be preferable to what the United States largely has now: one in which price differences are “opaque” and in which payers with market power force weaker ones to cover disproportionate shares of providers’ costs.In the “new” category, two articles focus on bundled payment approaches. David Miller and coauthors report that payments for inpatient surgical procedures under Medicare vary by 49–130 percent across hospitals and thus seem ripe for bundled payment. Peter Hussey and coauthors strike the “blue” note, reporting that implementing the PROMETHEUS bundled payment model in pilot sites has been slow going, partly because of the complexities of layering it on top of the existing—and problematic—fee-for-service system. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 November 2011 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download

Stroke initial severity and outcome relative to insurance status in a universal health care system in Switzerland

Socioeconomic status is thought to have a significant influence on stroke incidence, risk factors and outcome. Its influence on acute stroke severity, stroke mechanisms, and acute recanalisation treatment is less known. Over a 4-year period, all ischaemic stroke patients admitted within 24h were entered prospectively in a stroke registry. Data included insurance status, demographics, risk factors, time to hospital arrival, initial stroke severity (NIHSS), etiology, use of acute treatments, short-term outcome (modified Rankin Scale, mRS). Private insured patients (PI) were compared with basic insured patients (BI). Of 1062 consecutive acute ischaemic stroke patients, 203 had PI and 859 had BI. They were 585 men and 477 women. Both populations were similar in age, cardiovascular risk factors and preventive medications. The onset to admission time, thrombolysis rate, and stroke etiology according to TOAST classification were not different between PI and BI. Mean NIHSS at admission was significantly higher for BI. Good outcome (mRS≤2) at 7days and 3months was more frequent in PI than in BI. We found better outcome and lesser stroke severity on admission in patients with higher socioeconomic status in an acute stroke population. The reason for milder strokes in patients with better socioeconomic status in a universal health care system needs to be explained.