R. Leidl, P. Potthoff, and D. Schwefel Health is a most vital resource represented in the degree of our well-being and our ability to conduct active and satisfactory lives. Acute and chronic illnesses diminish such well-being and abilities and may require resources for medical or nursing care. The improvement in health status, a major objective of health policy, requires the measurement of the severity of diseases and their consequences as essential elements of information. In application, the measurement approaches are gaining in relevance as they become more feasible and as more experience is gathered about their implementation and utilization. The feasibility of these new information tools is supported by developments in data processing technologies that permit broadly based empirical applications. Wider applications lead to improvements in the management use of this information. At the European level, better indicator systems of diseases and their various aspects are facing an increasing demand for patient-based health and health system comparisons and analyses. The measurement of health status and its implications can comprise a number of dimensions: various concepts of health and disease, types of diseases, methodological approaches of measurement, purposes of application and states of implementation.

From the early days of its recognized occurrence, AIDS has been per ceived as posing tremendous threats, burdens and challenges to human beings. Individuals, societies and, in a global point of view, mankind are affected by the effects of the HN infection, the nature and extent of which is still unclear in many ways. In the beginning only biomedical and epidemiological analyses of the problem were the top research priori ties, the former laden with great hopes that it may soon be possible to stop the spread of the disease and to overcome its physical impact. Yet it soon became clear that AIDS would be something to be reckoned and coped with on a long-term basis, making a thorough investigation of its impact absolutely mandatory. AIDS has serious economic consequences. Taken seriously, they can not be confined to predictions of costs intended to support the AIDS issue in the struggle for resources. Besides cost calculations - a method ologically tricky and wide-ranging topic in itself -and their application to cost-effectiveness and other analyses, economic issues include identify ing and assessing patterns of care, analyzing problems of financing, exploring impacts on markets other than health care, and modelling scenarios for future developments and strategies. At present, the eco nomic aspects of AIDS still constitute a very recent topic in European health economics and health systems research. Many projects are just about to start, and there must be a better exchange of information between research groups.

Since the early 1970s, delivery of care to people who are consid- ered to suffer from chronic psychotic disturbances has been at a crossroads. In 1983, the European Regional Office of the World Health Organization (WHO), within its health economics pro- gramme, encouraged international research on the economic impli- cations of alternative strategies of care for those patients. Origi- nally, it was intended to compare at least two or more strategies of managing chronic psychotics, especially strategies which place dif- ferent emphasis on inpatient and outpatient care. Instead of designing a fully coordinated, multinational, multi- centre study based on a mutually agreed on study protocol, we de- cided on the following: - To meet with researchers interested in the social, psychological, and economic features of health care for chronic psychotic pa- tients - To stimulate ongoing research projects or to initiate new ones - To discuss quite different approaches from international and - terdisciplinary points of view - To review and revise the diversified end products of such an open research process For this purpose, we outlined a broad range of topics which could be included in the study: - Methodological problems of evaluation in this field - Social and economic implications of psychiatric deinstitutiona- zation - Scenarios of various degrees of deinstitutionalization - Assessment of (hospital) costs of the treatment for chronic sc- zophrenic and other psychotic patients - Public and private costs of the main treatment strategies - Time-expenditure analyses of chronic psychotic patients

It is not easy to summarize the studies that have dealt with the health effects of un employment on the unemployed. The main problem impeding a comparison of their results is the diversity of theoretical constructs associated with physical and especially mental health and, above all, an apparently inexhaustible variety of op erationalizations of these constructs. It is significant that the six conclusions drawn from the present state of unemployment research by the organizers of a re cent conference on the individual and social consequences of unemployment in cluded the following request: "In view of the relevant constructs, it seems to be most urgent to find or to develop operationalizations which can be agreed upon, in order to guarantee comparability of research results" (Kieselbach and Wacker 1985, p. XX; my translation). Nevertheless, the results of these studies allow the statement that a negative in fluence of job loss on psychological well-being can be regarded as a validated finding. The influence on physical health, however, must be assessed very careful ly and in a differentiated manner. The few investigations dealing with this ques tion arrive at different conclusions; moreover, possibly relieving effects of unem ployment on health come into sight."

Variablen ............................................................. 103 Diagnosen ............................................................. 109 Tabellenanhang ....................................................... 115 Literatur .............................................................. 247 Verzeichnis der Abbildungen Abb. 1. Auftretenshaufigkeiten ausgewahlter Diagnosengruppen nach Altersgruppen der Patienten .. . . . . . . . . . . . . . . . . . . .. . . 33 . . . . . . . Abb.2. Haufigkeitsverteilungen der Patienten mit ausgewahlten Diagnosengruppen nach Altersgruppen der Patienten .................................................. 39 Abb.3. Haufigkeitsverteilung der Patienten nach Diagnosenzahl ................................................. 66 Abb. 4. Variablenherkunft .............................................. 104 Verzeichnis der Tabellen im Text Tabelle 1. Scheine nach Scheinart, Behandlungsart, Fachgruppe und Bezirk ..................................... 5 Tabelle 2. Arzte nach Fachgruppe, Scheinzahl in der Stichprobe und Bezirk ................................................. 6 Tabelle 3. Patienten nach Geschlecht, KassenzugehOrigkeit, Versicherten-und Altersgruppen sowie Wohnort . . . . . . . . . . . . . . . 8 Tabelle 4. Patienten nach Alters-und Versichertengruppen .............. 9 Tabelle 5. Patienten nach Behandlungsart .............................. 9 Tabelle 6. Patienten nach Behandlungsart und Anzahl der Scheine (= Anzahl der Arzte) . . . . . . . . . . . . . . . . . . .. . . 10 . . . . . . . . Tabelle 7. Patienten nach Anzahl der Behandlungstage und Geschlecht ............................................. 11 Tabelle 8. Patienten nach Fachgruppe der konsultierten Arzte und nach Geschlecht ............................................ 13 Tabelle 9. Patienten nach Inanspruchnahme von Allgemeinarzten oder Facharzten und nach Alter ....... ......................... 14 Tabelle 10. Patienten nach Inanspruchnahme von Primiir-oder Sekundararzten und nach Alter .............................. 15 Tabelle 11. Patienten nach Scheinart .................................... 16 Tabelle 12. Patienten nach Anzahl und Art der verwendeten Scheine .............................. . . . . . . .. . . 17 Tabelle 13. Patienten nur in kurativer Behandlung und nur mit Uberweisungs-oder Belegarztscheinen nach Patientenmerkmalen ........................................ 18 Tabelle 14. Haufigste Einzelleistungen nach Abrechnungshaufigkeit und Ansatz in Patienten ....................................... . 19 XII Tabelle 15. Patienten nach Inanspruchnahme von Leistungsgruppen ...................................... 19 Tabelle 16. Patienten nach Alter, Geschlecht, Versichertengruppe unct Wohnort sowie nach Kassenzugehorigkeit ..................... 21 Tabelle 17. Patienten nach Inanspruchnahmemerkmalen und Kassenart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 22 . . . . . . . . . . . . . . . Tabelle 18. Patienten nach Inanspruchnahme von Arztgruppen und Kassenart . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . 23 . . . . . . . . . . . . ."

Der vorliegende Band enthalt den AbschluBbericht Uber ein Forschungs- projekt, das die Gesellschaft fur Strahlen- und Umweltforschung (GSF) im Auf trag des Bayerischen Staatsministeriums fUr Arbeit und Sozial- ordnung (StMAS) und in Zusammenarbeit sowohl mit diesem Ministerium a 1 s auch mi t den Landes verb and en der Orts-, Betri ebs- und Innungs- krankenkassen in Bayern, der Landwirtschaft1ichen Krankenkasse Ober- bayern und der Kassenarzt1ichen Vereinigung Bayerns durchgefUhrt hat. Ausgangspunkt des Projekts war das gemeinsame Interesse der genann- ten Institutionen an einer wissenschaft1ichen Begleitung und Bewer- tung der "Gesamtvertrage zwi schen den Landesverbanden der bayer i- schen RVO-Kassen und der Kassenarzt 1 i chen Verei ni gung Bayerns mi t GUltigkeit yom 1. 7. 1979 (genannt Bayern-Vertrag)"; die recht1iche Grund1age der Forschungsarbeiten bi1deten zwei Vertrage, die am 1. 12. 1980 abgesch10ssen wurden: - erstens ei n "Werkvertrag" zwi schen dem Frei staat Bayern, vertreten durch das StMAS, und der GSF, in dem der Forschungsauftrag an das lnst itut fUr Med; z; n; sche lnformat i k und Systemforschung (MEDlS) der GSF definiert sowie seine administrative und finanzielle Ab- wicklung geregelt wird; - zweitens ein "Kooperationsvertrag" zwischen allen Beteiligten, in dem deren Rechte und Aufgaben bei der Ausarbeitung wie auch Ver- wertung der Untersuchungsergebnisse festgelegt sind. Ein Bericht Uber die erste Phase der Studie wurde von der Arbeits- gruppe Soziookonomie des MEDIS-Instituts der GSF 1982 veroffentlicht (Schwefe1 et a1. 1982).