Continental Western Europe

The chapter analyses the commonalities and transformations of the Bismarckian welfare systems of continental Western Europe. In these systems, social insurance is the primary delivery mechanism, access to benefits is mainly based on work and contribution record, benefits are mainly in cash and calculated as a proportion of past earnings, the biggest share of the financing comes from social contributions paid by employers and employees, and the governance and management of these systems is partly run by collective, compulsory social insurance funds. These features dominate the welfare systems of Germany, France, Belgium, Austria, and, to a lesser degree, the Netherlands. The first part of the chapter focuses on the origins of these systems, the main goals they tried to achieve through their historical development, and the specific principles on which they rely. The second part shows how these systems developed and functioned during their Golden Age, emphasizing their institutional traits and complementarities with certain forms of industrial capitalism. The third part analyses the specificities of the crises these systems are facing, especially the cost of labour. The final part presents the various sequences of welfare reform that have led these systems to adopt structural reforms, especially. The conclusion focuses on the dualization processes that characterize the main changes of Bismarckian welfare systems.

Information Needs of Patients Undergoing Bariatric Surgery in Germany: A Qualitative Interview Study

BackgroundObesity is a worldwide problem with different treatment options. Bariatric surgery is an effective treatment for severe obesity; however, it leads to drastic changes (e.g., changes in everyday life and eating behavior) for patients, which may lead to information needs. Our aim was to identify the information needs of patients undergoing bariatric surgery and to explore the information provision within the healthcare process of bariatric surgery in Germany.MethodsWe conducted n=14 semi-structured telephone interviews between April 2018 and April 2019. The interview guide was designed prior to the interviews and consisted of 4 main sections (demographic information, pre- and postoperative healthcare provision, information needs). The audio-recorded interviews were transcribed verbatim and analyzed using qualitative content analysis with MAXQDA software.ResultsThere were unmet information needs with two factors (time: pre/postoperative and categories of information: general/specific) to be considered. Due to the patients’ description of information, we categorized information into general (different surgical procedures, general nutritional information) and specific (occurring simultaneously with a problem) information. Most patients felt well informed concerning general information. However, it was pointed out that it was not possible to provide complete information preoperatively, as the need for information only arises when there are postoperative (specific) problems. In addition, there seems to be a high demand for specific postoperative information regarding nutrition and nutrition-related problems. However, patients stated that postoperative nutritional counseling is not reimbursed by health insurance funds. The information conveyed in support groups and the exchange of experiences are highly valued by patients. However, some patients describe the information provided within the support groups as unfiltered, frightening or exaggerated.ConclusionOverall, there were unmet information needs. Reimbursement by health insurance funds could increase the use of postoperative nutritional counseling and thus serve existing information needs. Support groups enable an exchange of experiences and therefore offer low-barrier access to information. Cooperation between support groups and healthcare professionals in information provision could be an approach to improving existing information needs or to avoiding the development of information gaps. Furthermore, the development and implementation of a digital solution for (postoperative) information dissemination could be helpful.

Comprehensive support for families with parental cancer (Family-SCOUT), evaluation of a complex intervention: study protocol for a non-randomized controlled trial

Background Families with minor children affected by parental cancer are at risk of considerable emotional and organizational stress that can severely burden all family members. So far, there has been a lack of comprehensive support services for affected families. The aim of this project is to implement and evaluate a complex psychosocial intervention for these families by providing advice, information, and care on an emotional, psycho-social, and communicative level during and after the cancer experience and across healthcare sectors. Methods Family-SCOUT is a project supported by the German Innovation Fund (https://innovationsfonds.g-ba.de/). The evaluation is based on a mixed-methods quasi-experimental design with the intervention and control groups. A standardized postal survey at three measurement points (T0: study enrollment; T1: 3 months of follow-up; T2: 9 months of follow-up), secondary data from the participating health insurance funds, and semi-structured qualitative interviews are used for summative and formative evaluation. The study aim is to include n=560 families. Data will be analyzed according to the intention-to-treat principle. The primary analysis is the comparison of the Hospital Anxiety and Depression Scale (HADS) response rates (minimal important difference (MID) ≥ 1.6 in at least one of the two parents) at T2 between the intervention and control group using Fisher’s exact test. The conduct of the study as well as the development and implementation of the intervention will be accompanied by comprehensive study monitoring following the principles of an effectiveness-implementation hybrid study. Discussion The results will allow to test the effectiveness and efficiency of the intervention for the target group. The first experience with the implementation of the intervention in model regions will be available. The evaluation results will serve as the basis to assess the need of including the intervention in the catalog of services of the statutory health insurance funds in Germany. Trial registration ClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019.

The effect of the universal two-child policy on medical insurance funds with a rapidly ageing population: evidence from China’s urban and rural residents’ medical insurance

Background With the rapid growth of the ageing population, the operating burden of China’s basic medical insurance fund is becoming increasingly heavy. To counter rapid population ageing and ameliorate a series of problems, China has adjusted its fertility policies several times. On January 1, 2016, the universal two-child policy was implemented. This study analysed the impacts of the adjustment to the fertility policy and potential improvements in fertility intention on the insured population and medical insurance fund sustainability. Methods We used an actuarial science method and took the urban and rural residents’ basic medical insurance (URRBMI) of China, which covers most urban and rural residents, as an example to build a dynamic forecast model of population growth and a dynamic actuarial model of medical insurance funds. Results Compared with the original policy, under the current fertility intention (40%) with the universal two-child policy, the ageing of the population structure of URRBMI participants will decline significantly after 2026, and individuals aged 65 and over will account for only 19.01% of the total participants in 2050. The occurrence of the current deficit and accumulated deficit of the URRBMI fund will be postponed for one year to 2022 and 2028, respectively. If fertility intentions continue to rise, the ageing degree of the population structure will decrease, and the deficit would be further delayed. Conclusions The universal two-child policy is conducive to improving the degree of overall population ageing, delaying the occurrence of a URRBMI fund deficit, and improving the sustainability of URRBMI funds. If fertility intention increases, the effects would be stronger. However, since the adjustment of the universal two-child policy has a certain time lag, it will take time to demonstrate this impact. Therefore, while actively promoting the universal two-child policy, other measures should be taken, such as improving the fertility desire among couples of childbearing age and reforming medical insurance payment methods.

Problems of income and expenditure balance of the pension fund budget of Ukraine

The steady budget deficit of the Pension Fund of Ukraine necessitates balancing its budget and finding effective opportunities to improve the current pension system. The revenue and expenditure part of the budgets of the Pension Fund for the last 7 years has been analyzed, time series characterizing various aspects of its activity have been constructed, polynomial modeling of trend series of revenues and expenditures has been carried out. To improve the actuarial basis of the joint pension system, it has been suggested to segregate social pensions, which are not provided by insurance premiums, and therefore cannot be the object of insurance payments, but should be subject to state (budget) funding. The shadow sector of the economy and the arrears of enterprises for the payment of salary to employees have been identified as a significant factor in the disproportion of the budget of the Pension Fund of Ukraine, measures to respond to these violations have been identified and analyzed. Relevant recommendations included a revision of the institutional position on limiting the amount of salaries on which SSC (single social contribution) is accrued, the redistribution of relevant contributions between employees and employers, and the harmonization of the accrual base with the average salary. Further research is recommended to focus on the peculiarities of balancing the revenues and expenditures of the budget of the Pension Fund in the case of entrusting it with the functions of other social insurance funds of Ukraine, as well as in connection with the introduction of the second level of pension provision.

The agenda of management accounting in healthcare

Subject. This article discusses changes in the economic and legislative environment of State-financed healthcare institutions, regulatory framework of the Russian Federation, which influences management accounting indicators. Objectives. I outline a system of relations in the design of management accounting indicators of State-financed healthcare institutions. Methods. The study is based on the methods of grouping, comparison, analysis, and generalization. I analyzed the current management accounting practice in State-financed medical institutions of the Voronezh Oblast. Results. Analyzing regulatory documents and industrial distinctions and difficulties in healthcare, I outlined a system of relations in the design of management accounting indicators in State-financed healthcare institutions. I traced factors that influence the creation of management accounting in State-financed healthcare institutions. I suggest implementing the practice of accounting for costs incurred per patient into the accounting and information system of management accounting. Aspects of statistical accounting should be integrated into the accounting process for this purpose. Conclusions and Relevance. The specifics of financing sources now influence a set of indicators and internal reporting in management accounting. Management accounting of income becomes a priority in management accounting as part of compulsory medical insurance funding. Management accounting of income and process designing approaches are getting more and more specific as the methods for paying the medical assistance with compulsory medical insurance funds get changed.

Exploring the Audit Supervision of China’s Medical Insurance Fund Based on the 2019 Medical Insurance Fund Audit Data

This study is mainly based on the auditing of medical insurance funds in the audit work report of the National Audit Office’s 2019 central and provincial and municipal budget implementation and other fiscal revenues and expenditures to conduct audit supervision of China’s medical insurance funds, based on the risk-oriented violation of regulations. Identify and evaluate the risks of each stage of the medical insurance fund from the perspective of risk of breaches, thus draw audit points, summarize the path of the medical insurance fund audit supervision so that that audit resources can be concentrated in important stages and key areas. Audit costs can be reduced, and build the regulatory system of the medical insurance fund audit will be constructed accordingly.

Formation of the social package at the enterprise: domestic and foreign experience

The article describes the definition of «social package» and the content, characteristics and social benefits to which the employee is entitled while working at the enterprise. The essence of the compensation package and its function at the enterprise are analyzed. Motivation has been highlighted material motivation, which effectively influences and motivates employees to a better result at work. Problems have been identified. The need to introduce a social package at the enterprise has been substantiated. The directions of improvement of documentation of a social package at the enterprises are covered. The practice of providing social packages to employees at Ukrainian enterprises has been presented. The neds of employees in the relevant social benefits had been identified. It has been proposed to form social packages taking into account employees' needs and interests. The works of Ukrainian teachers who dealt with the content of the social package at the enterprise have been analyzed. Issues of the content of the social package in Ukraine and abroad, in particular in the United States and Germany have been covered. In Ukraine, the content of the social package depends on which institution a person works in - public or private. It had been found that the US legislation prescribes the social benefits that the company must provide to its employers. It has been established that there is compulsory health and pension insurance, and contributions to state insurance funds depend on the amount of salary in Germany. Methods of filling the social package in Western countries have been highlighted. It was found that the social policy of enterprises influences the content of the social package.

Comprehensive support for families with parental cancer – Family-SCOUT: study protocol for the evaluation of a complex intervention

Background: Families with minor children affected by parental cancer are at risk of considerable emotional and organizational stress that can severely burden all family members. So far, there has been a lack of comprehensive support services for affected families. The aim of this project is to implement and evaluate a complex psychosocial intervention for these families by providing advice, information and care on an emotional, psycho-social and communicative level during and after the cancer experience and across healthcare sectors.Methods: Family-SCOUT is a project supported by the German Innovation Fund (https://innovationsfonds.g-ba.de/). The evaluation is based on a mixed method quasi-experimental design with intervention and control group. A standardized postal survey at three measurement points (T0: study enrollment; T1: 3 months follow-up; T2: 9 months follow-up), secondary data from the participating health insurance funds, and semi-structured qualitative interviews are used for summative and formative evaluation. Study aim is to include n=560 families. Data will be analyzed according to the intention-to-treat principle. The primary analysis is the comparison of the Hospital Anxiety and Depression Scale (HADS) response rates (minimal important difference (MID) ≥ 1.6 in at least one of the two parents) at T2 between the intervention and control group using Fisher’s exact test. The conduct of the study as well as the development and implementation of the intervention will be accompanied by comprehensive study monitoring following the principles of an effectiveness-implementation hybrid study. Discussion: Results will allow to test the effectiveness and efficiency of the intervention for the target group. First experience with the implementation of the intervention in model regions will be available. The evaluation results will serve as basis to assess the need of including the intervention in the catalogue of services of the statutory health insurance funds in Germany. Trial registration: ClinicalTrials.gov, NCT04186923. Retrospectively registered on 4 December 2019.

Cabbage crops in solving the problem feed protein in the Non-Chernozem zone

According to natural conditions, the non-black earth zone of Russia is the main region of concentration and specialization of meat and dairy cattle breeding, as well as pig and poultry breeding. In the near future, to ensure the food security of the region, including large industrial cities of Moscow, St. Petersburg and others, it will be necessary to produce about 20.8 million tons of milk, 4.6 million tons of meat, 16.6 billion eggs. To produce such a quantity of products, it is necessary to produce about 77 million tons of feed units, including 40 million voluminous and 37 million concentrated feed, including insurance funds and livestock re-production. The most important condition for the effective use of feed is provided with their protein (feed protein) [1–3]. Scientific and practical experience shows that in solving the problem of providing forage with protein, the leading role in the Non-Black Earth Zone belongs to cold and frost-resistant oilseeds, and above all rapeseed. In the Federal Williams Research Center of Forage Production & Agroecology, highly productive varieties have been created, technological bases for their cultivation have been developed, which ensure the seed productivity of spring forms up to 3.5 t/ha and winter crops - up to 6 t / ha of oilseeds. The development and implementation of the rapeseed sowing program in the zone will allow meeting the needs for vegetable oils, producing in the required volumes high-protein supplements in the form of oilcakes and meal for animal husbandry and poultry farming.