Extent and structure of health insurance expenditures for complementary and alternative medicine in Swiss primary care

BACKGROUND: The study is part of a nationwide evaluation of complementary and alternative medicine (CAM) in primary care in Switzerland. The goal was to evaluate the extent and structure of basic health insurance expenditures for complementary and alternative medicine in Swiss primary care. METHODS: The study was designed as a cross-sectional evaluation of Swiss primary care providers and included 262 certified CAM physicians, 151 noncertified CAM physicians and 172 conventional physicians. The study was based on data from a mailed questionnaire and on reimbursement information obtained from health insurers. It was therefore purely observational, without interference into diagnostic and therapeutic procedures applied or prescribed by physicians. Main outcome measures included average reimbursed costs per patient, structured into consultation- and medication-related costs, and referred costs. RESULTS: Total average reimbursed cost per patient did not differ between CAM physicians and conventional practitioners, but considerable differences were observed in cost structure. The proportions of reimbursed costs for consultation time were 56% for certified CAM, 41% for noncertified CAM physicians and 40% for conventional physicians; medication costs--including expenditures for prescriptions and directly dispensed drugs--respectively accounted for 35%, 18%, and 51% of costs. CONCLUSION: The results indicate no significant difference for overall treatment cost per patient between CAM and COM primary care in Switzerland. However, CAM physicians treat lower numbers of patients and a more cost-favourable patient population than conventional physicians. Differences in cost structure reflect more patient-centred and individualized treatment modalities of CAM physicians.

The 1985 catastrophic drainage of a moraine-dammed lake, Khumbu Himal, Nepal: cause and consequences

On 4 August 1985 Dig Tsho, a moraine-dammed glacial lake in the Khumbu area of eastern Nepal, burst above Thame. For the region close to the origin of the outbreak the consequences were catastrophic. The destruction of a newly built hydroelectricp ower plant, 14 bridges, about 30 houses, and many hectares of valuable arable land, as well as a heavily damaged trail network, resulted from 5 million m3 of water plummetting down the Bhote Kosi and Dudh Kosi valleys. The breaching of the moraine was triggered by wave action following an ice avalanche of 150,000 m3 into the lake. The surge had a peak discharge of 1,600 m3/sec; 3 million m3 of debris were moved within a distance of less than 40 km. However, only 10-15 percent of the material left the region as suspended load. The potential hazard of glacial lakes persists and increases. A hazard assessment including an identificationo f source areas and subsequent monitoring of glacial lakes is proposed. It should be incorporated into any development concept for the Himalayan region.

Selective sampling during catastrophic disruption: Mapping the location of reaccumulated fragments in the original parent body

In this paper, we simulate numerically the catastrophic disruption of a large asteroid as a result of a collision with a smaller projectile and the subsequent reaccumulation of fragments as a result of their mutual gravitational attractions. We then investigate the original location within the parent body of the small pieces that eventually reaccumulate to form the largest offspring of the disruption as a function of the internal structure of the parent body. We consider four cases that may represent the internal structure of such a body (whose diameter is fixed at 250 km) in various early stages of the Solar System evolution: fully molten, half molten (i.e., a 26 km-deep outer layer of melt containing half of the mass), solid except a thin molten layer (8 km thick) centered at 10 km depth, and fully solid. The solid material has properties of basalt. We then focus on the three largest offspring that have enough reaccumulated pieces to consider. Our results indicate that the particles that eventually reaccumulate to form the largest reaccumulated bodies retain a memory of their original locations in the parent body. Most particles in each reaccumulated body are clustered from the same original region, even if their reaccumulations take place far away. The extent of the original region varies considerably depending on the internal structure of the parent. It seems to shrink with the solidity of the body. The fraction of particles coming from a given depth is computed for the four cases, which can give constraints on the internal structure of parent bodies of some meteorites. As one example, we consider the ureilites, which in some petrogenetic models are inferred to have formed at particular depths within their parent body. (C) 2014 Elsevier Ltd. All rights reserved.

Shaping Tolerant Attitudes towards Immigrants: The Role of Welfare State Expenditures

This article contributes to the ongoing discussion on how tolerance may be fostered in Western European countries and to the question of how contextual factors such as welfare state expenditures may contribute to this formation. Tolerance is understood as a basic democratic principle that helps civil societies cope with rising levels of diversity stemming from increased immigration and individualism. Within the tolerance literature it is commonly agreed upon that a comprehensive welfare state is capable of bridging class divides and overcoming social categorization. However, over the past decades European welfare states experienced an ongoing influx of immigrants, challenging their general purpose and increasing notions of ‘welfare chauvinism’. Drawing on insights from both tolerance and welfare state solidarity literature, we implement hierarchical analyses based on Eurobarometer data to assess the potential influence of welfare state universalism on political and social tolerance in 15 Western European countries. Moreover, we demonstrate that this relationship is highly conditional on the degree of ethnic heterogeneity within a country.