Einfluss von Fatigue und kognitiven Einschränkungen auf die Inanspruchnahme von Gesundheitsleistungen, Arbeitsleistung und Lebensqualität (Utility)

Influence of fatigue and cognitive impairment on the use of health services, work performance and quality of life (utility): A study with 5,475 patients with multiple sclerosis in Germany Introduction: People with multiple sclerosis (MS) experience a number of neurological problems beyond the general outcome measures of relapses and disability that can independently affect costs and quality of life. Objectives: To investigate the effect of self-assessed fatigue and subjective cognitive impairment on direct healthcare consumption, work participation and utility in Germany. Methods: The study included 5,475 participants and investigated – in addition to all resource consumption – fatigue, cognitive impairment and the effect of MS while at work using visual analogue scales (VAS 0–10). The analysis controlled for gender, age, disease duration, education, disability, and use of disease-modifying treatments. Results: The level of fatigue and cognitive impairment was significantly and independently correlated with all resource utilisation, workforce participation and utility (p<0.0001). For each VAS point increase in severity, the probability of working was reduced by 10.6% for cognitive impairment and 4.9% for fatigue, while utility decreased by 0.03 for each point. Work hours decreased in linear fashion with each point of increasing severity for both symptoms, while sick leave increased accordingly. Both symptoms significantly affected productivity at work. Conclusions: The effect of fatigue and impaired cognition on work capacity has been shown in an international study, but demonstrating their effect on resource consumption requires a large single-country sample. This German analysis demonstrates their effect on all economic resources, both direct and indirect.

The ‘German Way’ of Curbing Public Debt

Public debt: relevance for funding of modern states – Keynesian revolution – Consequences of the financial crisis in Germany – Introduction of the debt brake and Fiscal Compact – The constitutional debt brake: structure and exceptions of the balanced budget rule, four deficiencies of the debt brake – The Fiscal Compact: historical background and structure of the balanced budget rule – Sufficient implementation of the balanced budget rule in Germany? – Constitutionality of the Fiscal Compact? – Austerity as the wrong answer for solving the current economic problems