Showing papers on "European union published in 2014"
Posted Content•
TL;DR: The Customs Union Issue was originally published in 1950 by the Carnegie Endowment for International Peace and set the framework for the contemporary debate over the benefits or otherwise of preferential trading agreements such as the European Union, NAFTA, and APEC.
Abstract: Jacob Viner's The Customs Union Issue was originally published in 1950 by the Carnegie Endowment for International Peace. It set the framework for the contemporary debate over the benefits or otherwise of preferential trading agreements such as the European Union, NAFTA, and APEC. Viner developed the concepts of trade creation and diversion in this work as he pioneered the analysis of the global politics of trade agreements. This revival of Viner's classic work includes an introduction that places this book in the context of his life's work and the post-WWI economic and political situation. The introduction also traces the reception of Viner's work and discusses its continuing relevance for international economists, political scientists, and historians. Available in OSO:
1,472 citations
TL;DR: Data of large-scale randomised trials support initiation of HPV-based screening from age 30 years and extension of screening intervals to at least 5 years, and provide 60-70% greater protection against invasive cervical carcinomas compared with cytology.
1,281 citations
Charité1, Medical University of Graz2, University of Southern Denmark3, Medical University of Silesia4, University of Genoa5, Federal University of São Paulo6, Autonomous University of Barcelona7, University of Coimbra8, St. John's University9, Hiroshima University10, Medical University of South Carolina11, Hannover Medical School12, Hospital Kuala Lumpur13, Johns Hopkins University14, University of Zurich15, University of Manitoba16, University of Mainz17, University of Toronto18, Technion – Israel Institute of Technology19, University of Bari20, Peking University21
TL;DR: This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms, and outlines evidence-based diagnostic and therapeutic approaches for the different subtypes ofUrticaria.
Abstract: This guideline is the result of a systematic literature review using the 'Grading of Recommendations Assessment, Development and Evaluation' (GRADE) methodology and a structured consensus conference held on 28 and 29 November 2012, in Berlin. It is a joint initiative of the Dermatology Section of the European Academy of Allergy and Clinical Immunology (EAACI), the EU-funded network of excellence, the Global Allergy and Asthma European Network (GA(2) LEN), the European Dermatology Forum (EDF), and the World Allergy Organization (WAO) with the participation of delegates of 21 national and international societies. Urticaria is a frequent, mast cell-driven disease, presenting with wheals, angioedema, or both. The life-time prevalence for acute urticaria is approximately 20%. Chronic spontaneous urticaria and other chronic forms of urticaria do not only cause a decrease in quality of life, but also affect performance at work and school and, as such, are members of the group of severe allergic diseases. This guideline covers the definition and classification of urticaria, taking into account the recent progress in identifying its causes, eliciting factors and pathomechanisms. In addition, it outlines evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS).
1,150 citations
TL;DR: Monoclonal antibodies continue their march on the markets, and optimized so-called biobetter versions of existing biologics are also gaining ground, but the rate of biosimilar approvals has seen a dramatic slowdown in recent years.
Abstract: Monoclonal antibodies continue their march on the markets, optimized so-called biobetter versions of existing biologics are also gaining ground, but the rate of biosimilar approvals has seen a dramatic slowdown in recent years.
993 citations
TL;DR: Recommendations to improve the surveillance of morbidity and mortality in homeless people are discussed, including programmes focused on high-risk groups, such as individuals leaving prisons, psychiatric hospitals and the child welfare system, and the introduction of national and state-wide plans that target homeless people.
977 citations
TL;DR: Loss-of-function mutations in APOC3 were associated with low levels of triglycerides and a reduced risk of ischemic cardiovascular disease.
Abstract: Background High plasma levels of nonfasting triglycerides are associated with an increased risk of ischemic cardiovascular disease. Whether lifelong low levels of nonfasting triglycerides owing to mutations in the gene encoding apolipoprotein C3 (APOC3) are associated with a reduced risk of ischemic cardiovascular disease in the general population is unknown. Methods Using data from 75,725 participants in two general-population studies, we first tested whether low levels of nonfasting triglycerides were associated with reduced risks of ischemic vascular disease and ischemic heart disease. Second, we tested whether loss-of-function mutations in APOC3, which were associated with reduced levels of nonfasting triglycerides, were also associated with reduced risks of ischemic vascular disease and ischemic heart disease. During follow-up, ischemic vascular disease developed in 10,797 participants, and ischemic heart disease developed in 7557 of these 10,797 participants. Results Participants with nonfasting triglyceride levels of less than 1.00 mmol per liter (90 mg per deciliter) had a significantly lower incidence of cardiovascular disease than those with levels of 4.00 mmol per liter (350 mg per deciliter) or more (hazard ratio for ischemic vascular disease, 0.43; 95% confidence interval [CI], 0.35 to 0.54; hazard ratio for ischemic heart disease, 0.40; 95% CI, 0.31 to 0.52). Heterozygosity for loss-of-function mutations in APOC3, as compared with no APOC3 mutations, was associated with a mean reduction in nonfasting triglyceride levels of 44% (P<0.001). The cumulative incidences of ischemic vascular disease and ischemic heart disease were reduced in heterozygotes as compared with noncarriers of APOC3 mutations (P = 0.009 and P = 0.05, respectively), with corresponding risk reductions of 41% (hazard ratio, 0.59; 95% CI, 0.41 to 0.86; P = 0.007) and 36% (hazard ratio, 0.64; 95% CI, 0.41 to 0.99; P = 0.04). Conclusions Loss-of-function mutations in APOC3 were associated with low levels of triglycerides and a reduced risk of ischemic cardiovascular disease. (Funded by the European Union and others.)
740 citations
TL;DR: This work received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no.
Abstract: This work received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement no. REGPOT-CT2012-316331-POLARIS. The work was also funded by FEDER through the Competitive Factors Operational Program (COMPETE) and by National funds through the Portuguese Foundation for Science and Technology (FCT) in the scope of the projects PTDC/FIS/115048/2009 and PTDC/CTM-BIO/1814/2012. The authors gratefully acknowledge Dr. Luca Gasperini (3B's Research Group, University of Minho, Portugal) for his help with the figures.
673 citations
TL;DR: In this article, six different strategies have been proposed for the European Union (EU) energy system in the European Commission's report, Energy Roadmap 2050, the objective for these strategies is to ide...
672 citations
TL;DR: This study provides virological confirmation of MERS-CoV in camels and suggests a recent outbreak affecting both human beings and camels.
Abstract: Summary Background Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe lower respiratory tract infection in people. Previous studies suggested dromedary camels were a reservoir for this virus. We tested for the presence of MERS-CoV in dromedary camels from a farm in Qatar linked to two human cases of the infection in October, 2013. Methods We took nose swabs, rectal swabs, and blood samples from all camels on the Qatari farm. We tested swabs with RT-PCR, with amplification targeting the E gene (upE), nucleocapsid ( N ) gene, and open reading frame (ORF) 1a. PCR positive samples were tested by different MERS-CoV specific PCRs and obtained sequences were used for phylogentic analysis together with sequences from the linked human cases and other human cases. We tested serum samples from the camels for IgG immunofluorescence assay, protein microarray, and virus neutralisation assay. Findings We obtained samples from 14 camels on Oct 17, 2013. We detected MERS-CoV in nose swabs from three camels by three independent RT-PCRs and sequencing. The nucleotide sequence of an ORF1a fragment (940 nucleotides) and a 4·2 kb concatenated fragment were very similar to the MERS-CoV from two human cases on the same farm and a MERS-CoV isolate from Hafr-Al-Batin. Eight additional camel nose swabs were positive on one or more RT-PCRs, but could not be confirmed by sequencing. All camels had MERS-CoV spike-binding antibodies that correlated well with the presence of neutralising antibodies to MERS-CoV. Interpretation Our study provides virological confirmation of MERS-CoV in camels and suggests a recent outbreak affecting both human beings and camels. We cannot conclude whether the people on the farm were infected by the camels or vice versa, or if a third source was responsible. Funding European Union projects EMPERIE (contract number 223498), ANTIGONE (contract number 278976), and the VIRGO consortium.
615 citations
TL;DR: In this article, the authors examined the large-scale consequences in the European Union of replacing 25-50% of animal-derived foods with plant-based foods on a dietary energy basis, assuming corresponding changes in production.
Abstract: Western diets are characterised by a high intake of meat, dairy products and eggs, causing an intake of saturated fat and red meat in quantities that exceed dietary recommendations. The associated livestock production requires large areas of land and lead to high nitrogen and greenhouse gas emission levels. Although several studies have examined the potential impact of dietary changes on greenhouse gas emissions and land use, those on health, the agricultural system and other environmental aspects (such as nitrogen emissions) have only been studied to a limited extent. By using biophysical models and methods, we examined the large-scale consequences in the European Union of replacing 25–50% of animal-derived foods with plant-based foods on a dietary energy basis, assuming corresponding changes in production. We tested the effects of these alternative diets and found that halving the consumption of meat, dairy products and eggs in the European Union would achieve a 40% reduction in nitrogen emissions, 25–40% reduction in greenhouse gas emissions and 23% per capita less use of cropland for food production. In addition, the dietary changes would also lower health risks. The European Union would become a net exporter of cereals, while the use of soymeal would be reduced by 75%. The nitrogen use efficiency (NUE) of the food system would increase from the current 18% to between 41% and 47%, depending on choices made regarding land use. As agriculture is the major source of nitrogen pollution, this is expected to result in a significant improvement in both air and water quality in the EU. The resulting 40% reduction in the intake of saturated fat would lead to a reduction in cardiovascular mortality. These diet-led changes in food production patterns would have a large economic impact on livestock farmers and associated supply-chain actors, such as the feed industry and meat-processing sector.
611 citations
TL;DR: This work was supported by the Joint DECC/Defra Met Office Hadley Centre Climate Programme (GA01101), the UK Public Weather Service research program, and the European Union Framework 7 SPECS project.
Abstract: This work was supported by the Joint DECC/Defra Met Office Hadley Centre Climate Programme (GA01101), the UK Public Weather Service research program, and the European Union Framework 7 SPECS project. Leon Hermanson was funded as part of his Research Fellowship by Willis as part of Willis Research Network (WRN).
TL;DR: An overview of the international efforts on these reactor types carried out in the framework of Generation-IV can be found in this article, where the authors give an overview of international R&D efforts.
TL;DR: The study found that facilitating conditions and behavioral intentions directly influence mBanking adoption, and initial trust, performance expectancy, technology characteristics, and task technology fit have total effect on behavioral intention.
TL;DR: In this paper, the authors acknowledge three research grants/contracts that are supporting their current research on this theme: Grant F/07 040/AP from the Leverhulme Trust, Grant NE/F014597/1 from the Natural Environment Research Council, UK, and the this paperORM collaborative project funded by the European Union Seventh Framework Programme under grant agreement 282656.
Abstract: I would like to acknowledge three research grants/contracts that are supporting my current research on this theme: Grant F/07 040/AP from the Leverhulme Trust; Grant NE/F014597/1 from the Natural Environment Research Council, UK, and the REFORM collaborative project funded by the European Union Seventh Framework Programme under grant agreement 282656.
TL;DR: Despite the favourable mortality trends worldwide, in some countries the declines are becoming less marked, and the predictions for 2015 show that a levelling off of rates is expected in the USA and a few other countries.
TL;DR: In this paper, the authors presented the results of a project with the European Research Council and EPLANET (European Union) with the objective of supporting the development of a research network in the field of nuclear energy.
Abstract: Austrian Federal Ministry of Science and Research and the Austrian Science Fund; the Belgian Fonds de la Recherche Scientifique and Fonds voor Wetenschappelijk Onderzoek; the Brazilian Funding Agencies (CNPq, CAPES, FAPERJ, and FAPESP); the Bulgarian Ministry of Education and Science; CERN; the Chinese Academy of Sciences, Ministry of Science and Technology, and National Natural Science Foundation of China; the Colombian Funding Agency (COLCIENCIAS); the Croatian Ministry of Science, Education and Sport, and the Croatian Science Foundation; the Research Promotion Foundation, Cyprus; the Ministry of Education and Research, Recurrent Financing Contract No. SF0690030s09 and European Regional Development Fund, Estonia; the Academy of Finland, Finnish Ministry of Education and Culture, and Helsinki Institute of Physics; the Institut National de Physique Nucleaire et de Physique des Particules/CNRS and Commissariat a l’Energie Atomique et aux Energies Alternatives/CEA, France; the Bundesministerium fur Bildung und Forschung, Deutsche Forschungsgemeinschaft, and Helmholtz-Gemeinschaft Deutscher Forschungszentren, Germany; the General Secretariat for Research and Technology, Greece; the National Scientific Research Foundation and National Innovation Office, Hungary; the Department of Atomic Energy and the Department of Science and Technology, India; the Institute for Studies in Theoretical Physics and Mathematics, Iran; the Science Foundation, Ireland; the Istituto Nazionale di Fisica Nucleare, Italy; the Korean Ministry of Education, Science and Technology and the World Class University program of NRF, Republic of Korea; the Lithuanian Academy of Sciences; the Mexican Funding Agencies (CINVESTAV, CONACYT, SEP, and UASLP-FAI); the Ministry of Business, Innovation and Employment, New Zealand; the Pakistan Atomic Energy Commission; the Ministry of Science and Higher Education and the National Science Centre, Poland; the Fundacao para a Ciencia e a Tecnologia, Portugal; JINR, Dubna, the Ministry of Education and Science of the Russian Federation, the Federal Agency of Atomic Energy of the Russian Federation, Russian Academy of Sciences, and the Russian Foundation for Basic Research; the Ministry of Education, Science and Technological Development of Serbia; the Secretaria de Estado de Investigacion, Desarrollo e Innovacion and Programa Consolider-Ingenio 2010, Spain; the Swiss Funding Agencies (ETH Board, ETH Zurich, PSI, SNF, UniZH, Canton Zurich, and SER); the National Science Council, Taipei; the Thailand Center of Excellence in Physics, the Institute for the Promotion of Teaching Science and Technology of Thailand, Special Task Force for Activating Research and the National Science and Technology Development Agency of Thailand; the Scientific and Technical Research Council of Turkey and the Turkish Atomic Energy Authority; the Science and Technology Facilities Council, United Kingdom; the U.S. Department of Energy and the U.S. National Science Foundation.Individuals have received support from the Marie-Curie program and the European Research Council and EPLANET (European Union); the Leventis Foundation; the A. P. Sloan Foundation; the Alexander von Humboldt Foundation; the Belgian Federal Science Policy Office; the Fonds pour la Formation a la Recherche dans l’Industrie et dans l’Agriculture (FRIA-Belgium); the Agentschap voor Innovatie door Wetenschap en Technologie (IWT-Belgium); the Ministry of Education, Youth and Sports (MEYS) of the Czech Republic; the Council of Science and Industrial Research, India; the Compagnia di San Paolo (Torino); the HOMING PLUS programme of Foundation for Polish Science, cofinanced by EU, Regional Development Fund; and the Thalis and Aristeia programmes cofinanced by EU-ESF and the Greek NSRF.
TL;DR: Individual Member States (MSs) can still use flexibility granted by the new CAP to design national plans to protect farmland habitats and species and to ensure long-term provision of ecosystem services.
Abstract: In December 2013, the European Union (EU) enacted the reformed Common Agricultural Policy (CAP) for 2014–2020, allocating almost 40% of the EU's budget and influencing management of half of its terrestrial area. Many EU politicians are announcing the new CAP as “greener,” but the new environmental prescriptions are so diluted that they are unlikely to benefit biodiversity. Individual Member States (MSs), however, can still use flexibility granted by the new CAP to design national plans to protect farmland habitats and species and to ensure long-term provision of ecosystem services.
TL;DR: Cancer mortality predictions for 2014 confirm the overall favorable cancer mortality trend in the EU, translating to an overall 26% fall in men since its peak in 1988, and 20% in women, and the avoidance of over 250,000 deaths in 2014 compared with the peak rate.
TL;DR: Charron et al. as mentioned in this paper presented the European QoG Index (EQI) on the quality of government (QoG) at national and sub-national levels in twenty-seven European Union countries.
Abstract: Charron N., Dijkstra L. and Lapuente V. Regional governance matters: quality of government within European Union member states, Regional Studies. This study presents novel data (European QoG Index – EQI) on the ‘quality of government’ (QoG) – understood as low corruption, impartial public services and rule of law – for national and sub-national levels in twenty-seven European Union countries. The EQI shows notable within-country variations: while high-performing regions in Italy and Spain (for example, Bolzano, Pais Vasco) rank amongst the best European Union regions, others perform well below the European Union average. The index is highly correlated with sub-national levels of socio-economic development and levels of social trust, yet political decentralization is uncorrelated with greater within-country, or higher levels of overall, QoG.
TL;DR: In this paper, an assessment of economic flood risk trends across Europe reveals high current and future stress on risk financing schemes, and the magnitude and distribution of losses can be contained by investing in flood protection, increasing insurance coverage or by expanding public compensation funds.
Abstract: An assessment of economic flood risk trends across Europe reveals high current and future stress on risk financing schemes. The magnitude and distribution of losses can be contained by investing in flood protection, increasing insurance coverage or by expanding public compensation funds. However, these climate change adaptation instruments have vastly different efficiency, equity and acceptability implications. Moreover, the spatial variation in disaster risk can necessitate cross-subsidies between individual countries in the European Union.
01 Jan 2014
TL;DR: In this paper, a working definition of a smart city is established and the cities fitting this definition across the Member States are mapped, and an analysis of the objectives and Europe 2020 targets of Smart City initiatives finds that despite their early stage of development, Smart City objectives should be more explicit, well defined and clearly aligned to city development, innovation plans and Europe2020 in order to be successful.
Abstract: This report was commissioned to provide background information and advice on Smart Cities in the European Union (EU) and to explain how existing mechanisms perform. In exploring this, a working definition of a Smart City is established and the cities fitting this definition across the Member States are mapped. An analysis of the objectives and Europe 2020 targets of Smart City initiatives finds that despite their early stage of development, Smart City objectives should be more explicit, well defined and clearly aligned to city development, innovation plans and Europe 2020 in order to be successful.
TL;DR: After evaluating a safety signal regarding pancreatitis and pancreatic cancer in patients using incretin-based drugs, the Food and Drug Administration and the European Medicines Agency conclude that assertions of a causal association are inconsistent with the data as mentioned in this paper.
Abstract: After evaluating a safety signal regarding pancreatitis and pancreatic cancer in patients using incretin-based drugs, the Food and Drug Administration and the European Medicines Agency conclude that assertions of a causal association are inconsistent with the data.
TL;DR: Exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination, and bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades.
Abstract: Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar–acid–ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality.
TL;DR: The use of macroalgal ABs on crop plants can generate multiple benefits with reported effects including enhanced rooting, higher crop and fruit yields, freezing, drought and salt tolerance, enhanced photosynthetic activity and resistance to fungi, bacteria and virus.
Abstract: A biostimulant is an organic material that, when applied in small quantities, enhances plant growth and development such that the response cannot be attributed to the application of traditional plant nutrients. This review is aimed at highlighting developments in the processing of macroalgae for agricultural biostimulants (AB), summarising the biologically active components of brown macroalgae and examining the factors supporting the use of macroalgal AB for managing abiotic and biotic stresses in crop plants. The policy drivers supporting the use of macroalgal-derived ABs in agriculture are also emphasised. We examine the use of macroalgal ABs in crop production and evaluated the benefits of seed priming, foliar application, soil drenches and hydroponic treatments. The use of macroalgal ABs on crop plants can generate multiple benefits with reported effects including enhanced rooting, higher crop and fruit yields, freezing, drought and salt tolerance, enhanced photosynthetic activity and resistance to fungi, bacteria and virus. ABs can be applied as an alternative, or used in conjunction with synthetic crop protection products and plant growth regulators, and may have a role in maintaining crop production levels, health and quality in the future when many active ingredients will be lost to the industry due to changes in European Union regulations. Worldwide, macroalgae remain largely unexploited, we highlight some of the future research and development priorities.
TL;DR: In this article, the authors compare 26 EU countries in 2007-2011 and re-analyses 78 national surveys to examine changes in democratic support at the country level, using a series of cross-classified multilevel logistic regression models.
Abstract: The Great Recession that started in 2007/2008 has been the worst economic downturn since the crisis of the 1930s in Europe. It led to a major sovereign debt crisis, which is arguably the biggest challenge for the European Union (EU) and its common currency. Not since the 1950s have advanced democracies experienced such a dramatic external imposition of austerity and structural reform policies through inter- or supranational organisations such as the EU and the International Monetary Fund (IMF) or as implicitly requested by international financial markets. Did this massive interference with the room for maneuver of parliaments and governments in many countries erode support for national democracy in the crisis since 2007? Did citizens realise that their national democratic institutions were no longer able to effectively decide on major economic and social policies, on economic and welfare state institutions? And did they react by concluding that this constrained democracy no longer merited further support? These are the questions guiding this article, which compares 26 EU countries in 2007�2011 and re-analyses 78 national surveys. Aggregate data from these surveys is analysed in a time-series cross-section design to examine changes in democratic support at the country level. The hypotheses also are tested at the individual level by estimating a series of cross-classified multilevel logistic regression models. Support for national democracy � operationalised as satisfaction with the way democracy works and as trust in parliament � declined dramatically during the crisis. This was caused both by international organisations and markets interfering with national democratic procedures and by the deteriorating situation of the national economy as perceived by individual citizens.
TL;DR: In this article, the authors aimed to determine human health risks associated via food chain contamination of heavy metals routing from irrigation of urban and industrial wastewater, which is a major threat to ecological integrity and human well-being.
TL;DR: A state-of-art overview of recycling is provided together with an outlook for the future by using popular polymers such as polyolefins, poly(vinyl chloride), polyurethane, and poly(ethylene terephthalate) as examples.
Abstract: Plastics are inexpensive, easy to mold, and lightweight. These and many other advantages make them very promising candidates for commercial applications. In many areas, they have substantially suppressed traditional materials. However, the problem of recycling still is a major challenge. There are both technological and economic issues that restrain the progress in this field. Herein, a state-of-art overview of recycling is provided together with an outlook for the future by using popular polymers such as polyolefins, poly(vinyl chloride), polyurethane, and poly(ethylene terephthalate) as examples. Different types of recycling, primary, secondary, tertiary, quaternary, and biological recycling, are discussed together with related issues, such as compatibilization and cross-linking. There are various projects in the European Union on research and application of these recycling approaches; selected examples are provided in this article. Their progress is mirrored by granted patents, most of which have a very limited scope and narrowly cover certain technologies. Global introduction of waste utilization techniques to the polymer market is currently not fully developed, but has an enormous potential.
TL;DR: The aim of this study is the generation of a harmonised high-resolution soil erodibility map (with a grid cell size of 500 m) for the 25 EU Member States with an average 15% decrease of the K-factor.
TL;DR: In this paper, the EKC hypothesis was investigated with regards to the relationship between carbon emissions, income and energy consumption in 16 EU (European Union) countries, and the results showed that the inverted U-shape relationship does not hold for carbon emissions in the 16 EU countries.
01 Jan 2014
TL;DR: The German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing, however, it still needs improvement in some areas, such as the quality of care.
Abstract: This analysis of the German health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health care system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population are covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% are covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system in Germany is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources on health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health care system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, the German health care system still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges for the German health care system, as it leads to inequalities.