This paper demonstrates the application of cost effectiveness analysis and cost benefit analysis to alternative avalanche risk reduction strategies in Davos, Switzerland. The advantages as well as limitations of such analysis for natural hazards planning are discussed with respect to 16 avalanche risk reduction strategies. Scenarios include risk reduction measures that represent the main approaches to natural hazards planning in Switzerland, such as technical, organisational, and land use planning measures. The methodologies used outline how concepts and techniques from risk analysis, hazard mapping, Geographic Information System, and economics can be interdisciplinary combined. The results suggest important considerations, such as possible sources of uncertainty due to different choices in the calculation of cost effectiveness ratio and net present value. Given the parameters and assumptions, it seems as if the current approach to avalanche risk reduction in the study area approximates to economic and cost efficiency and serves the aim of reducing risk to human fatalities.

This study investigates the determinants of regional variations in health care expenditures (HCE) in Switzerland, since there are significant differences between cantons per capita HCE. The empirical analysis contributes to the discussion on the outcome of federalism in the Swiss health care system by improving the understanding of the determinants of the differences in HCE. Our econometric estimations indicate that HCE are significantly related to the density of specialist physicians, density of dispensing doctors, per capita income, proportion of managed care, medical and technological progress and socio-economic factors. Due to the presumptive importance of the organisation of ambulatory care, we suggest policy makers should particularly concentrate on promoting the supply of managed care models in Switzerland. Supporting the development of managed care may help to countervail some of the influences which tend to lead to higher cantonal health expenditures.

IntroductionThis study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.MethodsThe empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006–2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.ResultsOur estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5%, respectively, of the variation in total health care expenditure can be attributed to the effects of selection.ConclusionsIntegrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy-makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

Abstract. Decision-making for protection measures against natural hazards entails major complexities for final decision makers. The issue in question does not only implicate a variety of criteria that need to be considered but also scarce financial resources make the allocation decision a difficult task. Furthermore, these decisions appear to be multidisciplinary in nature. Stakeholders from experts over politicians and the public are among the affected parties in making and dealing with the consequences of such decisions. In order to capture the complexity that arises when incorporating the varieties of interests as well as impacts protection measures have on the environment, the economy and society, transparent and multidisciplinary decision support techniques are needed. This paper looks at how Cost Benefit Analysis (CBA), a tool already applied to decisions concerning protective measures, and Multi Criteria Analysis (MCA), even though new to the field as such but already successfully practiced in other environmental areas, perform according to the abovementioned criteria. A conceptual overview of the methodologies will be given along with a discussion of the respective strengths and weaknesses. Looking at past applications, this overview gives an analysis about the potential of socio economics in its contribution to natural hazard research.

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