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ABSTRACT: BACKGROUND: Positive screening results are often associated not only with target-disease-specific but also with non-target-disease-specific mortality. In general, this association is due to joint risk factors. Cost-effectiveness estimates based on decision-analytic models may be biased if this association is not reflected appropriately. OBJECTIVE: To develop a procedure for quantifying the degree of bias when an increase in non-target-disease-specific mortality is not considered. METHODS: We developed a family of parametric functions that generate hazard ratios (HRs) of non-target-disease-specific mortality between subjects screened positive and negative, with the HR of target-disease-specific mortality serving as the input variable. To demonstrate the efficacy of this procedure, we fitted a function within the context of coronary artery disease (CAD) risk screening, based on HRs related to different risk factors extracted from published studies. Estimates were embedded into a decision-analytic model, and the impact of 'modelling increased non-target-disease-specific mortality' was assessed. RESULTS: In 55-year-old German men, based on a risk screening with 5 % positively screened subjects, and a CAD risk ratio of 6 within the first year after screening, incremental quality-adjusted life-years were 19 % higher and incremental costs were 8 % lower if no adjustment was made. The effect varied depending on age, gender, the explanatory power of the screening test and other factors. CONCLUSION: Some bias can occur when an increase in non-target-disease-specific mortality is not considered when modelling the outcomes of screening tests.
The European Journal of Health Economics 12/2012; · 1.50 Impact Factor
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ABSTRACT: BACKGROUND: Patients undergoing major orthopaedic surgery (MOS), such as total hip (THR) or total knee replacement (TKR), are at high risk of developing venous thromboembolism (VTE). For thromboembolism prophylaxis, the oral anticoagulant rivaroxaban has recently been included in the German diagnosis related group (DRG) system. However, the cost-effectiveness of rivaroxaban is still unclear from both the German statutory health insurance (SHI) and the German hospital perspective. Objectives To assess the cost-effectiveness of rivaroxaban from the German statutory health insurance (SHI) perspective and to analyse financial incentives from the German hospital perspective. METHODS: Based on data from the RECORD trials and German cost data, a decision tree was built. The model was run for two settings (THR and TKR) and two perspectives (SHI and hospital) per setting. RESULTS: Prophylaxis with rivaroxaban reduces VTE events (0.02 events per person treated after TKR; 0.007 after THR) compared with enoxaparin. From the SHI perspective, prophylaxis with rivaroxaban after TKR is cost saving (E27.3 saving per patient treated). However, the costeffectiveness after THR (E17.8 cost per person) remains unclear because of stochastic uncertainty. From the hospital perspective, for given DRGs, the hospital profit will decrease through the use of rivaroxaban by E20.6 (TKR) and E31.8 (THR) per case respectively. CONCLUSIONS: Based on our findings, including rivaroxaban for reimbursement in the German DRG system seems reasonable. Yet, adequate incentives for German hospitals to use rivaroxaban are still lacking.
BMC Health Services Research 07/2012; 12(1):192. · 1.66 Impact Factor
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ABSTRACT: Breast cancer is the leading cause of death from cancer among women in Germany. Despite its clinical and economic relevance, no attributable costs for breast cancer have been reported for Germany so far. The objective of this study is to estimate age-specific breast cancer attributable health expenditures for Germany.
Sickness fund data from 1999 representing about 26 million insured (i.e. 32% of the total German population) have been analysed using generalized additive models and the error propagation law. Costs have been inflated to 2010.
Breast cancer attributable costs decreased with age. Among breast cancer patients aged 30-45 years, about 90% of all health expenditures were due to breast cancer, whereas in breast cancer patients aged 80-90 years, about 50% were due to breast cancer. Breast cancer attributable costs amounted to about €9,000 annually for patients below 55 years of age and declined to about €3,000 in 90-year-old breast cancer patients.
This analysis provides estimates of attributable breast cancer costs in Germany. Compared with the international literature, the estimates were plausible but had a tendency to underestimate breast cancer attributable costs.
PLoS ONE 01/2012; 7(12):e51312. · 4.09 Impact Factor
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ABSTRACT: This paper presents findings of a mandatory three-year evaluation of a prevention bonus scheme offered in the German Statutory Health Insurance (SHI). Its objective is to describe the rationale behind the programs, analyze their financial impact and discuss their implications on potentially conflicting goals on solidarity and competition.
The analysis included 70,429 insured enrolled in a prevention bonus program in a cohort study. The intervention group and their matched controls were followed for a three-year period. Matching was performed as nearest neighbor matching. The economic analysis comprised all costs relevant for Sickness Funds (SF) in the SHI and was carried out from a SHI perspective. Differences in cost trends between the intervention and the control group were examined applying the paired t-test.
Regarding mean costs there was a significant difference between the two groups of euro177.48 (90% CI [euro149.73; euro205.24]) in favor of the intervention group. If program costs were considered cost reductions of euro100.88 (90% CI [euro73.12; euro128.63]) were obtained.
The uptake of a prevention bonus program led to cost reductions in the intervention group compared to the control group even when program costs were considered. However, the results must be interpreted with caution as in addition to financial aspects, socio-economic and health-status, selection bias and the function and use of bonus programs as marketing tools, as well as their long-term sustainability should be considered in future assessments.
Health Policy 06/2010; 96(1):51-6. · 1.51 Impact Factor
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ABSTRACT: There are no data on the association between acute inflammation during critical illness and long-term mortality in ICU patients.
Nonsurgical patients with an ICU length of stay > 24 h surviving until ICU discharge were included into this prospective, observational, follow-up study. Demographics, chronic diseases, admission diagnosis, the Simplified Acute Physiology Score (SAPS) II, length of ICU stay, maximum C-reactive protein (CRP) levels during the ICU stay (CRPmax), and CRP levels at ICU discharge (CRPdis) were documented. After a follow-up time of 1.88 ± 1.16 years (range, 0.5-4 years), the survival status was determined.
Seven hundred sixty-five patients were enrolled into the study protocol. One hundred fifty-eight patients (20.7%) died within 0.62 ± 0.88 years after ICU discharge. Cumulative survival rates differed between patients grouped into the CRPmax and CRPdis quartiles. Patients in the first and second CRPmax quartiles had better cumulative survival rates than those in higher CRPmax quartiles (all P < .001). Patients in the first CRPdis quartile had better cumulative survival rates than those in higher CRPdis quartiles (all P < .001). Using adjusted Cox proportional hazards models, both CRPmax and CRPdis were independently associated with post-ICU mortality (both P < .001). Furthermore, the number of chronic diseases (P < .001), age (P < .001), and the SAPS II (P = .03) were associated with post-ICU mortality in both Cox models.
CRP levels during critical illness seem independently associated with post-ICU survival in nonsurgical ICU patients. Future research focusing on the association between acute systemic inflammation and post-ICU outcome is warranted in order to improve long-term survival of critically ill patients.
Chest 02/2010; 138(4):856-62. · 5.25 Impact Factor
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ABSTRACT: The aim of this study was to compare the predictive value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein (hs-CRP)-screening in addition to traditional risk factor screening in apparently healthy persons as a means of preventing coronary artery disease.
The systematic review was performed according to internationally recognized methods. Seven studies on risk prediction, one clinical decision-analytic modeling study, and three decision-analytic cost-effectiveness studies were included. The adjusted relative risk of high hs-CRP-level ranged from 0.7 to 2.47 (p < .05 in four of seven studies). Adding hs-CRP to the prediction models increased the areas under the curve by 0.00 to 0.027. Based on the clinical decision analysis, both individuals with elevated hs-CRP-levels and those with hyperlipidemia have a similar gain in life expectancy following statin therapy. One high-quality economic modeling study suggests favorable incremental cost-effectiveness ratios for persons with elevated hs-CRP and higher risk. However, many model parameters were based on limited evidence.
Adding hs-CRP to traditional risk factors improves risk prediction, but the clinical relevance and cost-effectiveness of this improvement remain unclear.
International Journal of Technology Assessment in Health Care 01/2010; 26(1):30-9. · 1.37 Impact Factor
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ABSTRACT: In decision modeling for health economic evaluation, bootstrapping and the Cholesky decomposition method are frequently used to assess parameter uncertainty and to support probabilistic sensitivity analysis. An alternative, Gauss's error propagation law, is rarely known but may be useful in some settings. Bootstrapping, the Cholesky decomposition method, and the error propagation law were compared regarding standard deviation estimates of a hypothetic parameter, which was derived from a regression model fitted to simulated data. Furthermore, to demonstrate its value, the error propagation law was applied to German administrative claims data. All 3 methods yielded almost identical estimates of the standard deviation of the target parameter. The error propagation law was much faster than the other 2 alternatives. Furthermore, it succeeded the claims data example, a case in which the established methods failed. In conclusion, the error propagation law is a useful extension of parameter uncertainty assessment.
Medical Decision Making 10/2009; 30(3):304-13. · 2.33 Impact Factor
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ABSTRACT: Coronary artery disease (CAD) is a major cause of death in industrial countries, leading to high health-related costs and decreased quality of life.
To develop and validate a decision-analytic model for CAD risk screening in Germany (German Coronary Artery Disease Screening Model).
Markov model.
Age- and gender-specific cohorts of the German population.
Mortality rates posted by the German Federal Statistical Office, the German Health Survey, social health insurance institutions, the MONICA Augsburg study, and the literature.
Lifetime.
CAD risk screening for high-risk individuals using Framingham risk equation and use of statins as the primary preventive measure, compared with a setting without screening.
Life-years (LY) gained, quality-adjusted life-years (QALYs) gained.
The model-based CAD incidence corresponds well with empirical data from the MONICA Augsburg study. Health outcomes depend on the screening threshold (cutoff value of Framingham 10-year risk) and on the age and gender of the cohort screened (0.03 to 0.26 LYs and 0.06 to 0.42 QALYs gained per person screened in cohorts of 50- and 60-year-old men and women, respectively).
The model provides a valid tool for evaluating the long-term effectiveness of CAD risk screening in Germany. Using statins as a primary prevention intervention for CAD in high-risk individuals identified by screening could improve the long-term health of the German population.
Medical Decision Making 09/2009; 29(5):619-33. · 2.33 Impact Factor
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ABSTRACT: To compare the predictive value and the clinical effectiveness of additional high sensitivity C-reactive protein (hs-CRP) screening as opposed to traditional risk factor screening alone as a strategy of primary prevention of coronary artery disease (CAD).
Following a comprehensive search of 26 electronic databases by DAHTA DIMDI, a systematic review was performed in accordance with international standards of evidence based medicine. Eight publications on risk prediction and one study addressing clinical decision-analytic modelling were included in the assessment.
The adjusted relative risk of a high hs-CRP level (> 3 mg/L) for myocardial infarction, cardiac related death, and cardiovascular events ranged from 0.7 to 2.47 (p < 0.05 in 4 of 7 studies). The area under the receiver operating characteristic curve (AUC) increased by 0.00 to 0.027 when hs-CRP was added to the prediction models (4 of 7 studies statistically significant with p < 0.05). Based on a published decision-analytic model examining hs-CRP screening, the gain in life expectancy due to statin therapy in individuals with elevated hs-CRP was similar when compared to patients with hyperlipidaemia. Nonetheless, evidence on many model parameters was limited.
Screening with hs-CRP in addition to traditional risk factors improves risk prediction. However, the incremental effect is moderate and the clinical relevance remains unclear.
Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2009; 103(6):319-29.
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ABSTRACT: In a substantial portion of patients (= 25%) with coronary heart disease (CHD), a myocardial infarction or sudden cardiac death without prior symptoms is the first manifestation of disease. The use of new risk predictors for CHD such as the high-sensitivity C-reactive Protein (hs-CRP) in addition to established risk factors could improve prediction of CHD. As a consequence of the altered risk assessment, modified preventive actions could reduce the number of cardiac death and non-fatal myocardial infarction.
Does the additional information gained through the measurement of hs-CRP in asymptomatic patients lead to a clinically relevant improvement in risk prediction as compared to risk prediction based on traditional risk factors and is this cost-effective?
A literature search of the electronic databases of the German Institute of Medical Documentation and Information (DIMDI) was conducted. Selection, data extraction, assessment of the study-quality and synthesis of information was conducted according to the methods of evidence-based medicine.
Eight publications about predictive value, one publication on the clinical efficacy and three health-economic evaluations were included. In the seven study populations of the prediction studies, elevated CRP-levels were almost always associated with a higher risk of cardiovascular events and non-fatal myocardial infarctions or cardiac death and severe cardiovascular events. The effect estimates (odds ratio (OR), relative risk (RR), hazard ratio (HR)), once adjusted for traditional risk factors, demonstrated a moderate, independent association between hs-CRP and cardiac and cardiovascular events that fell in the range of 0.7 to 2.47. In six of the seven studies, a moderate increase in the area under the curve (AUC) could be detected by adding hs-CRP as a predictor to regression models in addition to established risk factors though in three cases this was not statistically significant. The difference [in the AUC] between the models with and without hs-CRP fell between 0.00 and 0.023 with a median of 0.003. A decision-analytic modeling study reported a gain in life-expectancy for those using statin therapy for populations with elevated hs-CRP levels and normal lipid levels as compared to statin therapy for those with elevated lipid levels (approximately 6.6 months gain in life-expectancy for 58 year olds). Two decision-analytic models (three publications) on cost-effectiveness reported incremental cost-effectiveness ratios between Euro 8,700 and 50,000 per life year gained for the German context and between 52,000 and 708,000 for the US context. The empirical input data for the model is highly uncertain.
No sufficient evidence is available to support the notion that hs-CRP-values should be measured during the global risk assessment for CAD or cardiovascular disease in addition to the traditional risk factors. The additional measurement of the hs-CRP-level increases the incremental predictive value of the risk prediction. It has not yet been clarified whether this increase is clinically relevant resulting in reduction of cardiovascular morbidity and mortality. For people with medium cardiovascular risk (5 to 20% in ten years) additional measurement of hs-CRP seems most likely to be clinical relevant to support the decision as to whether or not additional statin therapy should be initiated for primary prevention. Statin therapy can reduce the occurrence of cardiovascular events for asymptomatic individuals with normal lipid and elevated hs-CRP levels. However, this is not enough to provide evidence for a clinical benefit of hs-CRP-screening. The cost-effectiveness of general hs-CRP-screening as well as screening among only those with normal lipid levels remains unknown at present.
GMS health technology assessment. 01/2009; 5:Doc06.
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ABSTRACT: The goal of this study was to investigate gender-specific differences in prevalence, healthcare costs, and treatment patterns in the German Statutory Health Insurance (SHI).
The study analyzed administrative claims data of over 26 million insured with respect to prevalence and cost of illness of six chronic diseases. Insured were identified using the ATC code for medication prescription and ICD-9 code for diagnosis. The influences of gender, age, and comorbidity on cost differences were analyzed via multivariate regression analysis.
Adjusted for age and comorbidity, gender had a significant influence on both hospital and medication spending. Hospital costs on average were 17.1% (95% CI 14.1; 20.2) higher for men compared with women. Medication spending for men exceeded that for women on average by 13.8% (95% CI 10.9; 16.7). The diagnoses with the highest prevalence were hypertension and heart failure. Women had a higher prevalence of diabetes, coronary artery disease (CAD), heart failure, and hypertension. Medication costs were higher for men in three of five diagnoses and comparable for two diagnoses (diabetes and asthma). Women received more medication prescriptions than men, but on average prescriptions for men were 14%-26% more expensive than prescriptions for women. Regarding treatment patterns men were treated with different drug classes in cardiovascular disease (CVD) compared with women. Total medication spending stratified by diagnosis was highest for diabetes.
Gender differences for costs and prescribing patterns for chronic diseases vary disease specifically, but generally men had higher inpatient costs and more expensive medication prescriptions, whereas women had higher numbers of prescriptions.
Journal of Women s Health 05/2008; 17(3):343-54. · 1.57 Impact Factor
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Stephanie Stock, Björn Stollenwerk,
Gabriele Klever-Deichert,
Marcus Redaelli,
Guido Büscher,
Christian Graf,
Klaus Möhlendick,
Jan Mai,
Andreas Gerber,
Markus Lüngen,
Karl W Lauterbach
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ABSTRACT: With the implementation of the Health Care Modernization Act in 2004 sickness funds in Germany were given the opportunity to award bonuses to their insured for health-promoting behavior. The aim of this study was to investigate the financial implications of a prevention bonus program from a sickness fund perspective.
The investigation was designed as a controlled cohort study (matched pair study) comprising 70,429 members in each group. Matching criteria were sex, postal code, insurance status, and cost categories for health care utilization. Insured opted into the program on a voluntary basis. The program consisted of interventions featuring primary prevention, modest exercise and immunization. Differences in cost trends between the two groups were examined using the paired t-test.
A reduction in mean costs of 241.11 Euro per active member for the year 2005 (90% CI = 348.70, 133.52; p-value < 0.001) could be achieved in the intervention group compared to the control group. When costs for the implementation of the program and the bonus payments were taken into account, there was a saving of 97.14 Euro per active member for the year 2005.
Preliminary results of a prevention bonus program in the German Statutory Health Insurance suggest a decrease in mean health care spending per enrollee. These effects may increase with time as long term effects of prevention become effective. However, further research is needed to understand how much of these short-term cost reductions can be attributed to the program itself rather than to possible confounders or volunteer bias and how the short-term savings may be accrued.
International Journal of Public Health 02/2008; 53(2):78-86. · 2.54 Impact Factor
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ABSTRACT: Progression-free survival (PFS) has not been validated as a surrogate endpoint for overall survival (OS) for anthracycline (A) and taxane-based (T) chemotherapy in advanced breast cancer (ABC). Using trial-level, meta-analytic approaches, we evaluated PFS as a surrogate endpoint.
A literature review identified randomized, controlled A and T trials for ABC. Progression-based endpoints were classified by prospective definitions. Treatment effects were derived as hazard ratios for PFS (HRPFS) and OS (HROS). Kappa statistic assessed overall agreement. A fixed-effects regression model was used to predict HROS from observed HRPFS. Cross-validation was performed. Sensitivity and subgroup analyses were performed for PFS definition, year of last patient recruitment, line of treatment, and constant rate assumption.
Sixteen A and fifteen T trials met inclusion criteria, producing seventeen A (n = 4,323) and seventeen T (n = 5,893) trial-arm pairs. Agreement (kappa statistic) between the direction of HROS and HRPFS was 0.71 for A (p = .0029) and 0.75 for T (p = .0028). While HRPFS was a statistically significant predictor of HROS for both A (p = .0019) and T (p = .012), the explained variances were 0.49 (A) and 0.35 (T). In cross-validation, 97 percent of the 95 percent prediction intervals crossed the equivalence line, and the direction of predicted HROS agreed with observed HROS in 82 percent (A) and 76 percent (T). Results were robust in sensitivity and subgroup analyses.
This meta-analysis suggests that the trial-level treatment effect on PFS is significantly associated with the trial-level treatment effect on OS. However, prediction of OS based on PFS is surrounded with uncertainty.
International Journal of Technology Assessment in Health Care 02/2008; 24(4):371-83. · 1.37 Impact Factor
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ABSTRACT: Die Einbeziehung der privaten Krankenversicherung (PKV) in den Risikostrukturausgleich (RSA) der gesetzlichen Krankenversicherung (GKV) wird häufig diskutiert. In der vorliegenden Studie wird anhand einer quantitativen Analyse unter Verwendung der Daten des Sozioökonomischen Panels (SOEP) abgeschätzt, welche Transfersumme aus dem System der PKV in das System der GKV fließen würden, wenn ein übergreifender RSA eingerichtet würde. Die Summe läge bei 9,9 Mrd. Euro pro Jahr unter Annahme der Beitragsbemessungsgrenze des Jahres 2006. Einbezogen wurden dabei nur die Unterschiede auf der Einnahmenseite des RSA. Einschränkend muss gesehen werden, dass unklar bleibt, welche Krankenversicherungsunternehmen be- oder entlastet würden und über welches Verfahren die Transfersumme aufgebracht werden könnte.
GRIR ; 3 , 2.
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ABSTRACT: Durch die ersten beiden Stufen der Tabaksteuererhöhung ging der Tabakkonsum insgesamt um 7,7% zurück. Besonders stark war der Rückgang bei den Kindern und Jugendlichen in der Altersgruppe von 12 bis 17 Jahren mit 13%. Dies ist ein großer gesundheitspolitischer Erfolg. Damit wurden die gesundheitspolitischen Ziele durch die ersten beiden Stufen der Tabaksteuererhöhung mehr als erreicht. Rauchen ist weltweit die größte vermeidbare verhaltensbedingte Ursache von koronarer Herzkrankheit, Lungen- und Bronchialkrebs, chronisch obstruktiven Atemwegserkrankungen, frühkindlichen Entwicklungsstörungen infolge Rauchens in der Schwangerschaft und von vorzeitigem Tod (DKFZ 2002). Die auf Tabakkonsum zurückgeführte Sterblichkeitsrate in Deutschland wird in der Länderübersicht der WHO für die Altersgruppe der 35-69jährigen mit 23% und über alle Altersgruppen mit 13% angegeben. Eine Verringerung des Zigarettenkonsums wirkt sich langfristig in verminderter vorzeitiger Mortalität aus - nach einem Rauchstopp nähern sich die Werte des Sterberisikos innerhalb von 10 Jahren denen der Nichtraucher an (Doll 2000). Die geringere Erkrankungswahrscheinlichkeit nach Rauchstopp und Konsumreduktion führt bereits kurzfristig zu einer Verminderung des medizinischen Versorgungsbedarfs. In diesem Gutachten wird berechnet, wie sich die 1. und 2. Stufe der Tabaksteuererhöhungen auf die wichtigsten durch Rauchen verursachten Krankheiten auswirken und wie sich die Zahlen für Neuerkrankungen und Sterbefälle reduzieren. Weiterhin wird berechnet, in welchem Ausmaß das Gesundheitssystem mittel- und langfristig durch Tabaksteuererhöhungen entlastet wird und welche Kostenreduktion durch die 3. Stufe der Tabaksteuererhöhung zu erwarten ist. Die Grundlage für die Berechnungen der Krankheitskosten sind direkte und indirekte Kosten. Mit direkten Kosten werden die Kosten angegeben, die in einem direkten Zusammenhang mit der medizinischen Behandlung (Operation, Arzneimittel etc.) stehen. Mit der Krankheitskostenrechnung des Statistischen Bundesamtes werden Kosten im Gesundheitswesen erstmals nach Krankheiten, Alter und Geschlecht differenziert (Statistisches Bundesamt 2004). Mit indirekten Kosten werden die Kosten angegeben, die durch Arbeitsausfall, Erwerbsunfähigkeit und vorzeitiges Versterben auf Grund von Krankheiten entstehen. (ICD2)
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ABSTRACT: Die Analyse beschäftigt sich mit der Möglichkeit der Einführung einer Bürgerversicherung im Bereich der Sozialen und Privaten Pflegeversicherung in Deutschland. Unter einer Bürgerversicherung wird dabei die Einbeziehung der gesamten Bevölkerung in Deutschland sowie die Einbeziehung aller Einkommensarten des Steuerrechts - mit Ausnahme von Mieteinkommen - in die Beitragsbemessung verstanden. Der Schwerpunkt der Untersuchung besteht in der Abschätzung des erzielbaren Beitragsaufkommens und darauf aufbauend in der Behebung der momentan zu beobachtenden Unterdeckung in der Sozialen Pflegeversicherung. In weiteren Schritten werden die Beitragssätze für die nächsten 20 Jahre auf der Basis eines ausgeglichenen Haushalts für die Pflegeversicherung als Bürgerversicherung ermittelt. Zu Grunde gelegt wird der Gesetzesstand zu Beginn des Jahres 2005, also bereits unter Einbeziehung der Anhebung des Beitragssatzes für Versicherte ohne Kinder. Als Grundlage der Berechnungen dienen die Daten des Sozio-ökonomischen Panels (SOEP) von 2002 des Deutschen Instituts für Wirtschaftsforschung (DIW), einer repräsentativen Stichprobe mit jährlich mehr als 22.000 Befragten. Die zentralen Ergebnisse lauten: (1) Die Analyse zeigt, dass eine Anhebung des Beitragssatzes von derzeit 1,7% bis 2007 nicht notwendig wird. (2) Ohne Einführung der Bürgerversicherung würde der Beitragssatz bis zum Jahre 2025 auf 2,33% demographiebedingt steigen. Mit der Verbesserung der Versorgung für Demenzerkrankte und der Anpassung der Pflegesätze in der ambulanten Pflege würde der Beitragssatz auf 2,52% steigen. (3) Durch die Einführung einer Bürgerversicherung könnte der Beitragssatz im Jahr 2006 auf 1,50% gesenkt werden einschließlich der verbesserten Versorgung Demenzkranker und der Anhebung ambulanter Pflegesätze. (4) Würde man bei Einführung der Bürgerversicherung den Beitragssatz von 1,7% beibehalten, könnten bis zum Jahr 2015 Rücklagen in der Bürgerversicherung Pflege angespart werden. (5) Ohne Ansparung von Rücklagen bliebe der Beitragssatz im Modell der Bürgerversicherung bis zum Jahre 2024 unter 2%. (ICG2)
Sozialwissenschaftlicher Fachinformationsdienst soFid.
