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International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care

November 20, 2014 Comments off

International Survey Of Older Adults Finds Shortcomings In Access, Coordination, And Patient-Centered Care
Source: Health Affairs

Industrialized nations face the common challenge of caring for aging populations, with rising rates of chronic disease and disability. Our 2014 computer-assisted telephone survey of the health and care experiences among 15,617 adults age sixty-five or older in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States has found that US older adults were sicker than their counterparts abroad. Out-of-pocket expenses posed greater problems in the United States than elsewhere. Accessing primary care and avoiding the emergency department tended to be more difficult in the United States, Canada, and Sweden than in other surveyed countries. One-fifth or more of older adults reported receiving uncoordinated care in all countries except France. US respondents were among the most likely to have discussed health-promoting behaviors with a clinician, to have a chronic care plan tailored to their daily life, and to have engaged in end-of-life care planning. Finally, in half of the countries, one-fifth or more of chronically ill adults were caregivers themselves.

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New Comparative Law Report — Approval of Medical Devices

November 14, 2014 Comments off

Approval of Medical Devices (PDF)
Source: Law Library of Congress

This report describes the approval process for medical devices in the European Union and fifteen countries, and also indicates whether or not an expedited approval procedure is available. Many of the countries reference EU law, including France, Germany, the Netherlands, and Switzerland. Israel more readily approves devices with a CE mark (indicating approval in the EU) or an indication that they are approved by the US Food and Drug Administration (FDA). In many nations, particularly those influenced by the EU, part of the review process is conducted not by the government but by private, independent organizations called “notified bodies.” These organizations are designated by EU Member States.

In most of the countries in the survey, medical devices are categorized based on the risks associated with their use, and the approval process varies by category. For example, in the United Kingdom, manufacturers of low-risk devices may register with the government agency and simply declare that the devices meet the requirements to be approved. Devices classed as higher risk must undergo more detailed review, by a notified body.

On the question of an expedited approval process, Australia, Canada, China, Japan, Spain, and Switzerland permit some sort of rapid review in particular cases, often when a device is required for an individual patient and no substitute is available. Mexico has provided for more rapid approval of devices if they have already been approved in either Canada or the United States. No such procedure exists at present in Brazil, France, Israel, the Russian Federation, or the United Kingdom. The Russian Federation did have a rapid approval system in place prior to August 2014. Germany provides for temporary approval of devices in limited circumstances. South Africa is now considering draft legislation that would include expedited procedures in specified situations.

What Would Happen If Health Care in the U.S. Improved?

October 23, 2014 Comments off

What Would Happen If Health Care in the U.S. Improved?
Source: Commonwealth Fund

The United States health care system is the most expensive in the world, but the Commonwealth Fund report Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally shows the U.S. underperforms relative to 11 other industrialized countries on most dimensions of performance. Use this interactive to see what would happen if the U.S. were to raise its health system performance to the levels achieved elsewhere in the world.

Global Pensions Asset Study – 2014

February 27, 2014 Comments off

Global Pensions Asset Study – 2014
Source: Towers Watson

This is a study of the 13 largest pension markets in the world and accounts for more than 85% of global pension assets. The countries included are Australia, Canada, Brazil, France, Germany, Hong Kong, Ireland, Japan, Netherlands, South Africa, Switzerland, the UK and the US. The study also analyses seven countries in greater depth by excluding the six smallest markets (Brazil, France, Germany, Ireland, Hong Kong and South Africa).

The analysis includes:

  • Asset size, including growth statistics, comparison of asset size with GDP and liabilities
  • Asset allocation
  • Defined benefit and defined contribution share of pension assets
  • Public and private sector share of pension assets.

Offshore Tax Evasion: The Effort to Collect Unpaid Taxes on Billions in Hidden Offshore Accounts

February 26, 2014 Comments off

Offshore Tax Evasion: The Effort to Collect Unpaid Taxes on Billions in Hidden Offshore Accounts (PDF)
Source: U.S. Senate Committee on Homeland Security & Government Affairs

This investigation arises from the Permanent Subcommittee on Investigations’ longstanding focus on offshore tax abuse, including U.S. taxpayers using hidden offshore accounts. In 2008 and 2009, the Subcommittee held three days of hearings and released a bipartisan report examining how some tax haven banks were deliberately helping U.S. customers hide their assets offshore to evade U.S. taxes. The hearings focused on two tax haven banks, UBS AG, the largest bank in Switzerland, and LGT, a private bank owned by the royal family of Liechtenstein.1 On the first day of the hearings, UBS acknowledged its role in facilitating U.S. tax evasion, apologized for its wrongdoing, and promised to end it. It later entered into a Deferred Prosecution Agreement with the U.S. Department of Justice, paid a $780 million fine, and turned over about 4,700 accounts with U.S. client names that had not been disclosed to the Internal Revenue Service (IRS). It also committed to disclosing to the IRS all future accounts opened for U.S. persons.

Since then, significant progress has been made in the effort to combat offshore tax abuses. World leaders have declared their commitment to reduce cross border tax evasion. Tax havens around the world have declared they will no longer use secrecy laws to facilitate tax dodging. In the United States, over 43,000 taxpayers joined a voluntary IRS disclosure program, came clean about their hidden offshore accounts, and paid over $6 billion in back taxes, interest, and penalties. In addition, Congress enacted the Foreign Account Tax Compliance Act (FATCA), which requires foreign banks to either disclose their U.S. customer accounts on an automatic, annual basis or pay a 30% tax on their U.S. investment income. Just this month, at the request of G8 and G20 leaders, the Organisation for Economic Co-operation and Development (OECD) issued a model agreement that, like FATCA, will enable countries to automatically exchange account information to fight cross border tax evasion.

On the negative side of the ledger, despite evidence of widespread misconduct by Swiss banks in facilitating U.S. tax evasion, Switzerland has continued to severely restrict the ability of Swiss banks to disclose the names of U.S. customers with undeclared Swiss accounts. As a result, the United States has obtained few U.S. names and little account information. In addition, despite the passage of five years, the U.S. Justice Department has failed to hold accountable the vast majority of the 4,700 UBS accountholders whose names were given to the United States. Aside from UBS, it has prosecuted only one of the Swiss banks suspected of misconduct, while setting up a program for hundreds of Swiss banks to obtain non-prosecution agreements without disclosing the names of a single U.S. customer with a hidden account. The promise of FATCA to disclose hidden offshore accounts has also dimmed due to regulations that opened disclosure loopholes which may enable many offshore accountholders to continue to conceal their accounts from U.S. authorities.

In this Report, the Subcommittee’s investigation chronicles these developments and provides an assessment of U.S. efforts to combat offshore tax evasion through hidden foreign accounts. It examines, in particular, ongoing roadblocks erected by the Swiss Government to block bank disclosure of the names of former U.S. customers with undeclared Swiss accounts. It uses as a case study a major Swiss bank, Credit Suisse, that was deeply involved in facilitating U.S. tax evasion and whose unnamed U.S. customers continue to owe unpaid U.S. taxes on billions of dollars in hidden assets.

OECD Review of Fisheries: Country Statistics 2013

January 13, 2014 Comments off

OECD Review of Fisheries: Country Statistics 2013
Source: Organisation for Economic Co-operation and Development

Fisheries (capture fisheries and aquaculture) supply the world each year with millions of tonnes of fish (including, notably, fish, molluscs and crustaceans). Fisheries as well as ancillary activities also provide livelihoods and income. The fishery sector contributes to development and growth in many countries, playing an important role for food security, poverty reduction, employment and trade.

This publication contains statistics on fisheries from 2005 to 2012. Data provided concern fishing fleet capacity, employment in fisheries, fish landings, aquaculture production, recreational fisheries, government financial transfers, and imports and exports of fish.

OECD countries covered

Australia, Belgium, Canada, Chile, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Japan, Korea, Luxembourg, Mexico, Netherlands, New Zealand, Norway, Poland, Portugal, Slovak Republic, Spain, Sweden, Switzerland, Turkey, United Kingdom, United States

Non-member economies covered

Argentina, Chinese Taipei, Thailand

Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality

June 3, 2013 Comments off

Explaining High Health Care Spending in the United States: An International Comparison of Supply, Utilization, Prices, and Quality
Source: Commonwealth Fund

This analysis uses data from the Organization for Economic Cooperation and Development and other sources to compare health care spending, supply, utilization, prices, and quality in 13 industrialized countries: Australia, Canada, Denmark, France, Germany, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. The U.S. spends far more on health care than any other country. However this high spending cannot be attributed to higher income, an older population, or greater supply or utilization of hospitals and doctors. Instead, the findings suggest the higher spending is more likely due to higher prices and perhaps more readily accessible technology and greater obesity. Health care quality in the U.S. varies and is not notably superior to the far less expensive systems in the other study countries. Of the countries studied, Japan has the lowest health spending, which it achieves primarily through aggressive price regulation.

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