Detlef Schwefel - Böcker

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.

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

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.