Management

Institute of Health Policy & ManagementActivities Report 2009 - 2010

ActivitiesReport2009-2010

COLOPHONActivities report 2009-2010Institute of Health Policy & ManagementFinal editing and production supervision:Marketing & Communications iBMGPhotography: Arno Bauman, Cok van den Berg, Eric Fecken, iBMG,Bill de Kimpe, Michelle Muus, Levien WillemseTranslation: Impact TaalburoDesign: B&T ontwerp en adviesPrint:Drukkerij van DeventerCopies: 2.000www.bmg.eur.nl/english

ContentsAmbitious and committed 4Research 8Competition and regulation in health care 12Hospital merger control 14Quality and efficiency in health care 16Socio-medical sciences 19Management and organisation of health care delivery 20Managed outcomes 24Global health: spearhead in research and education 26Caring by data 28Erasmus-Columbus 2013 30Education 32Bachelor Health Policy & Management 36Master Health Care Management 38Master Health Economics, Policy & Law 40Post-academic education: Erasmus CMDz 42Academy for Medical Specialists 44Management affairs 48Facts and figures 52Staff 54Academic Publications 59The Institute of Health Policy & Management is linkedwith Erasmus MC

1Ambitious andcommittedProf. Wilfried Notten, PhD, vice-deanIn the period 2009-2010 we have witnessed several important events that haveinfluenced iBMG’s positioning within Erasmus University Rotterdam (EUR). The moststriking one, no doubt, is the organisational transfer from Erasmus MC to EUR. A directconsequence of this repositioning was the election of the BMG-council in 2009.It is important to note that iBMG’s closepartnership with Erasmus MC has not beenaffected by this organisational transfer.On the contrary, cooperation in severalareas, such as health operationsmanagement, has been strengthenedduring the report period and new jointactivities were started. Regarding thelatter, I would like mention the importantarea of patient safety. The importance ofcooperation in this field was emphasisedby Jan Klein’s appointment to professor ofSafety in health care.At the same time, partnerships with otherfaculties in EUR have been intensified. Anillustrative example is the joint chair ofHealth law (Martin Buijsen) instituted bythe Erasmus School of Law (ESL) and iBMG.Worth mentioning as well is that we startedto explore the viability of (1) a collaborationbetween the Rotterdam School ofManagement (RSM) and iBMG for aninternational MBA Health, and (2) setting upa joint Diploma Course International Health& Policy Evaluation with the InternationalInstitute of Social Studies (ISS) and theErasmus MC department of Public Health(MGZ) as a stepping stone to a broadercollaboration in the field of Global Health.Following on to the announcement in theprevious report about the Institute’s newhousing, I can now confirm that since 2010all BMG sections have moved to J-buildingon campus Woudestein. With its fantasticambience this location is a real improvementon our former quarters.POSITION OF IBMGThe health care sector is the focus of all oureducational and research programmes.Political and social developments in the pastfew years had and will have far-reaching4

consequences forthe health care sectorin the Netherlands. Thescientific support iBMG can offeris determined by the nature andcomplexity of the problems.What is essential here is a multidisciplinaryapproach provided by legal experts, businessadministrators, economists, physicians, andothers. Crucially, iBMG’s research must beinnovative and application-oriented, sothat the findings are useful for practicalsolutions, also in situations where solutionsare not readily available.In spite of its broad knowledge basethe health care sector is so comprehensivethat iBMG was faced with making choicesfor research. A procedure including externalreview and intensive joint discussions withthe researchers at iBMG has resulted in 2008in a well-consideredchoice of three themes:u Competition and regulation inhealth careu Quality and efficiency in health careu Management and organisation ofhealth care deliveryDuring the report period researchefforts in these areas were further shaped,and the innovation budget provided anextra incentive for a multidisciplinaryapproach. This innovation budget forresearch was first made available by iBMGin 2007 and complements the existingfinancing scheme on the basis of scientificoutput, such as publications and PhDs.With regard to scientific performance:after a somewhat less satisfactory period,the scientific quality of research by iBMG5

– expressed in the CWTS score – is again onthe rise in the report period, i.e. up to 1.25;well over the world average! In addition,fifteen PHD-theses were published and sixinaugural lectures were delivered.Moreover, a wide range of workshops,symposia and conferences, both nationaland international were held on the initiativeof our Institute. To name a few: the SummerSchool on Health Law, the InternationalConference on Health Care Rationing andthe Health Care and Trade congress.Furthermore it is worth mentioning thatin 2010 the annual ESB Economists top-40again listed four economists employed byiBMG. Finally, among the awards and prizesreceived by iBMG staff are: the Prof. H.W.Lambers Prize, three ISPOR Awards, theNVZD thesis award, and a HarknessFellowship.The next years we will continue to givepriority to publishing our research findingsin internationally renowned peer reviewjournals, but not without overlookingthe societal importance of adequateinformation provision to the Netherlandshealth care sector. It is evident that iBMG’sresearch responds to society’s demand, forexample judged from the fact that morethan fifty percent of the research is financedvia the second en third flows of funds –independent public organisations such asZonMw and private bodies such as healthinsurers and pharmaceutical companies. Itshould not be left unmentioned, however,that funding, notably via the second flow offunds, appears to have come under pressurefrom political and social developments incombination with the economic slump.In the field of education, too, the results areimpressive. In the report period the studentbody continue to grow by some 10% yearlyand the proportion of international studentsin the Health Economics, Policy & Law (HEPL)master programme rose to some 30% of thetotal number of HEPL-students. This successstory is partly due to the health care sector’sgrowing need of graduates with knowledgeand experience in the fields of policymaking,organisation and management inhealth care. For the rest, these successes mayalso be ascribed to the quality of ourprogrammes.A point of attention is the success rateof our educational programmes, which webelieve could be improved. Preparationsfor improvement have started in 2010.These improvement measures are part ofa comprehensive restructuring programmewith which we aim to equip our educationalsystem more adequately for the teaching of agrowing number of students with a very largediversity in, for example, preparatory trainingand nationality. Finally, in collaboration withthe Erasmus School of Law the master inHealth Law was launched in 2009.Apart from the initial education, a wide rangeof targeted post-initial programmes andcourses is offered to managers and policymakersin the health care sector who arenot medical professionals, i.e. via the iBMGaffiliated Erasmus Centre for ManagementDevelopment in health care (Erasmus CMDz).In addition, the Academy for MedicalSpecialists – a collaboration between iBMGand the Order of Medical Specialists andVvAA, an insurance and service organisationfor (para)medics – offered a post-academicprogramme for medical-specialist managersand policy-makers.Furthermore, as mentioned above, theDiploma Course on International Health& Policy Evaluation was started in thereport period.6

The growth in studentnumbers and the increasinginterest of external parties tofinance research activities ofiBMG added pressure on ourstaff, resulting in a rapidgrowth of the number ofvacancies at our Institute. Staffsize increased from less than120 fte at the end of 2008 toaround 160 fte at the close of2010. Considering the abovementioneddevelopmentsconcerning external researchfunding, we effect that staffsize will stabilise around thisnumber in the coming years.In the report period we have welcomedthree new professors: Jan Klein (Safety inhealth care), Paul Robben (Effectiveness ofsupervision on the quality of health care)and Hans Severens (Evaluation research inhealth care). Furthermore, Werner Brouwerhas handed over his function as Director ofresearch to Erik Schut.In summary: 2009 and 2010 were highlydynamic, but undoubtedly also fascinatingyears for the field of health care. Ourresearchers have taken up the manyproblems and issues that arose with greatambition and commitment. You will find aselection of topics in this report. Please enjoythe read.7

2ResearchProf. Erik Schut, PhD, director of researchiBMG is a multidisciplinary Institute whose research activities are centred on complexissues in the domain of health care. The research programme has three main themes:(i) Competition and regulation in health care, (ii) Quality and efficiency in health care,(iii) Management and organisation of health care delivery.iBMG’s academic staff is organised intofive autonomous research groups: HealthServices Management & Organisation,Health Economics-iMTA, Law & Health Care,Health Care Governance, and HealthInsurance. Researchers from each groupparticipate in one or more main researchthemes.Growth, both qualitatively andquantitatively, is the veryword to describe iBMG’sresearch efforts overthe years 2009 and2010. For example,the number ofpublications ininternationalscientific peerreview journalshas considerablyincreased, from 100in 2007 to over 160 in 2010. Likewise, theimpact of our research, measured withthe CWTS citation score, has substantiallyincreased to over 60% above the worldaverage with regard to iBMG’s major fieldsof research.The growth is also reflected by the sharprise in the number of PhD students in theInstitute. Furthermore we haveacquired substantially moreexternal research grants(such as ZonMw grantsand Europeansubsidies).Between 2008and 2010 the sumtotal of externalresearch grantswent up from € 1.3million to over € 2.38

million. With the support of EU-fundingfive large European projects have beenlaunched, in which we closely collaboratewith various universities and researchinstitutions abroad (in China, Germany,the UK, India, Norway, Spain, Thailand,Vietnam, and other countries).In 2008, iBMG independently set up aninnovation fund (€ 500.000) to stimulateinnovative and multidisciplinary researchwithin the Institute. Since 2008 we haveannually awarded four outstandingPhD-studies a subsidy. Over the years 2009and 2010 a total of 15 PhD-students iniBMG have successfully defended theirdissertations.Within Erasmus University Rotterdam, iBMGhas further intensified research partnershipswith other faculties, such as Erasmus MC, theRotterdam School of Management (RSM),the Erasmus School of Economics (ESE), andthe Erasmus School of Law (ESL).Outside the university campus iBMG isworking more closely together with awide range of social partners, such as theInternational Institute of Social Studies(ISS), the Dutch National Institute for PublicHealth and the Environment (RIVM), IQHealthcare, the Netherlands Institute forHealth Services Research (Nivel), and theDutch Health Care Inspectorate (IGZ). Inaddition, iBMG is establishing more andmore research collaborations withinternational partners. Apart from variousEU-projects, iBMG has developed theRotterdam Global Health Initiative (RGHI)– together with ISS and the Erasmus MCdepartment of Public Health (MGZ) andsupported by the Executive Board and theEUR Holding. This initiative aims to promoteeducation, research, and consultancy in the9

health care domain in developing countries.The Rotterdam Global Health Initiative willactually be launched in 2011.Several iBMG researchers distinguishedthemselves personally. Through a one-yearfellowship of the Netherlands Institute forAdvances Study in the Humanities and SocialSciences (NIAS), Marleen Foets was able tostudy the extent to which current ethnicdisparities in access to health care might beexplained by social and cultural mechanisms.Antoinette de Bont was awarded aprestigious Harkness Fellowship of TheCommonwealth Fund, which allowed her toperform research at Kaiser Permanente inthe United States of America for one year,together with leading American experts inthe field of health care research. André denExter and Mahsa Ghari qualified for anErasmus Mundus Erasmus-Columbus 2013(ERACOL) grant. They both went to Panamaand studied possibilities to improvepublic health in Latin America. Having beenawarded the Dutch SoFoKles grant, bachelorstudents Anisma Gokoel and Zeynep Yildizwere able to gain more research experiencewithin iBMG.A number of researchers were recipientsof prestigious research prizes in 2009 and2010. Pepijn Vemer, Margreet Franken andAnnemieke Leunis received the prize for“Best New Investigator Research PodiumPresentation” of the International Societyfor Pharmacoeconomics and OutcomesResearch (ISPOR). Laura Burgers wasawarded the prize for “Best NewInvestigator Research Presentation”and Maureen Rutten-van Mölken receivedthe “ISPOR Award for Excellence inApplication of Pharmacoeconomics andHealth Outcomes Research.”10

For the coming years we are facing thechallenge of consolidating the researchbudget and the number of publications.In view of the decreasing availability ofsubsidies on the one hand, and theincreasing competition in the national andinternational markets on the other hand, weare truly facing an enormous challenge.This is why iBMG keeps investing in optimalfacilitation of its academic staff, so that ourresearchers can (continue to) do their workwith enthusiasm and commitment.I am pleased to give them the opportunityto explain the results and the societalimportance of their research efforts inthis report.11

Competition and regulationin health careResearch theme 1The research in this theme is primarily carried out by theresearch groups Health Care Governance, Health Insurance,Health Economics-iMTA, and Law & Health Care.CARE SYSTEMu Competition and competition policy in health care markets andhealth insurance markets (Schut, Varkevisser, Mosca)u Rationale and effects of hospital mergers (Roos, Schut,Varkevisser)u Determinants of use and the organisation and financing of long-term care (Bakx, Van Doorslaer, De Meijer, Koopmanschap, Schut,Van de Ven)u Changing modes of governance in health care (Bal, Grit, Putters,Van der Grinten, Zuiderent-Jerak)u Strategies by managers of health care organisations toaccommodate increasing entrepreneurial requirements(Grit, Stoopendaal, Van der Scheer, Meurs, Putters)u Changing positions of health care professionals and consequencesof training and education (De Bont, Meurs)u Creation of transparencies in health care; the influence ofperformance indicators on our view on quality of care and therole of rankings in health care (Bal)u Governance of innovation; towards a dynamic innovation policy(Putters, Zuiderent-Jerak)u Development and diffusion of innovation and innovationprocesses in the hybrid health care system, and within healthcare organisations (Putters, Stoopendaal, Meurs, Bal)u Science-policy relations in health care; building newinfrastructures for Knowledge to Action (Bal, De Bont, Van derGrinten)u Justice and solidarity in health care from a human rightsperspective (Buijsen)u Post mortem organ donation in the context of internationallaw (Buijsen)u Practices of organ donation in Dutch hospitals (Bal, Paul)12

INSURANCE MARKETu Risk equalisation among insurers (Van Vliet, Van de Ven, Van Kleef)u Cost sharing by consumers/patients (Van Kleef, Van Vliet, Van de Ven)u Construction of health care markets and their consequences(Grit, Van der Grinten, Zuiderent-Jerak, Bal)u Use of standardised agreements in health care purchasing byhealth insurers in view of competition law (Den Exter)u Preferred providers and health insurer impact on consumerchoice (Van der Geest, Laske)u Supplementary health insurance and group insurance (Schut,Van de Ven)u Equity in health care use in European countries (Van Doorslaer)u Health Equity and Financial Protection in Asia (HEFPA)(Van de Poel, Van Doorslaer)u Community Based Health Insurance (CBHI) in India (Dror, Rutten)PATIENT’S PERSPECTIVEu Consumer choice and switching behaviour in the health careand healthu Insurance markets (Laske, Schut, Van der Geest, Varkevisser)u Formulating the patient’s perspective in health care (Adams,Grit, Putters, Van de Bovenkamp)u New roles and responsibilities in the system of regulatedcompetition by studying health care networks at the regionaland local level; patient empowerment within the Wmo, Zvw,and AWBZ (Putters, Stoopendaal, Grit)u Equal treatment and access to health care and the implicationof market-oriented health care reform (Buijsen)u Unilateral termination of treatment contracts by the healthcare provider for non-medical reasons (Buijsen)u Motives and characteristics of care consumers with a personalcare budget (Oostrik, Huijsman)u Human rights and biomedicine (Den Exter)13

Research theme 1The introduction of the Health Insurance Act (Zvw) and the HealthCare Market Regulations Act (Wmg) has increased the room forcompetition in the Dutch health care system. It is thought thatcompetition would encourage health care providers, includinghospitals, to further improve quality of health care and have itorganised more effectively. In a competition driven health care system,strict enforcement of antitrust laws is essential. On both the supplyand demand sides parties should not be allowed to gain and abusemarket power. In other words, competition policy – including mergercontrol – should contribute to fair competition. As in other markets,increased competitive pressure in health care provokes consolidation.Because mergers reduce competition, proposed mergers must bereported and assessed prior to being consummated. The NetherlandsCompetition Authority (NMa) should prohibit mergers that result in adominant position.Merger control in health care markets is an important research topicwithin iBMG. The question of assessing the competitive effects ofhospitals mergers is particularly addressed. To safeguard effectivecompetition in this important market, health insurers as well aspatients should be able to choose from a sufficient number ofhospitals. In the Netherlands this is not self-evident. Over the years,mergers have substantially reduced the total number of hospitalorganisations. In order to guarantee sufficient choice options, the NMaHospital14

should be stringent when assessing proposed hospital mergers.Unfortunately, there is reason for concern on this issue since earlierNMa rulings show that the competition authority underestimatesthe adverse effects of hospital mergers on competition. Importantexamples in this context are the permitted hospital mergers betweenZiekenhuis Hilversum and Ziekenhuis Gooi Noord (2005), MC Alkmaarand Gemini Ziekenhuis (2007), and Ziekenhuis Walcheren andOosterscheldeziekenhuizen (2009).A more stringent assessment of hospital mergers is urgently needed,including a more accurate definition of relevant geographic hospitalmarkets. For this purpose, iBMG is analysing in detail why somepatients are willing to travel to hospitals farther away while othersare not. The innovative, empirical research on patients’ hospital choicebehaviour will provide a better insight into hospital substitutabilitythat underlies hospital competition. This research does not only resultin scientific publications in international peer-reviewed journals. It alsoleads to national publications, including policy recommendations,aimed at improving hospital merger control in the Netherlands.merger control“To guarantee sufficient freedom of choice, hospitalmergers in the Netherlands should be assessed morestringently. Research of iBMG on patients’ hospitalchoice behaviour and their willingness to travel isparticularly useful in this context.”Marco Varkevisser, PhD15

Quality and efficiencyin health careResearch theme 2The research in this theme is primarily carried out by the researchgroups Health Care Governance, Health Services Management &Organisation, Health Economics-iMTA, and Law & Health Care.METHODOLOGY AND APPLICATION OF ECONOMICEVALUATIONu Cost-effectiveness analysis of health care programmes (Al, Brouwer,Hakkaart, Koopmanschap, Poleij, Redekop, Rutten, Rutten-vanMölken, Severens, Stolk, Uyl-de Groot, Van Baal)u Utility measurement in economic evaluation of health care;studies investigating the elicitation of quality of life weights anddevelopment and validation of other utility-based outcomemeasures (Attema, Bleichrodt, Brouwer, Stolk, Van Exel)u Costing in economic evaluation of health care (Brouwer, Hakkaart,Koopmanschap, Severens, Tan, Van Baal)u Equity in economic evaluations; the elicitation and use of equityweights in economic evaluations from a societal perspective(Brouwer, Bleichrodt, Rutten, Stolk, Van Exel)u The role and use of value of information analysis (Al, Rutten-vanMölken, Severens)u Technology assessment reviews (Al, Severens)u The monetary value of health (Brouwer, Rutten, Van Exel)BASIC HEALTH CARE PACKAGE AND GUIDELINESu Pharmaceutical policy: how can value-based reimbursement systemsbe best organised and how can implementation of resultingdecisions be promoted? (De Bont, Koopmanschap, Rutten, Bal)u Incorporating economic evidence in practice guidelines (Brouwer,Buijsen, Hakkaart, Rutten, Rutten-van Mölken, Uyl-de Groot)u The role and construction of safety norms and guidelines for healthcare delivery (Bal, Zuiderent-Jerak)u The inclusion of diversity in guidelines: how do guideline developersin care for older adults accommodate diversity and variation inguidelines? (Zuiderent-Jerak)u Diversity in guidelines: what is the problem? (Zuiderent-Jerak,Van de Bovenkamp, Hakkaart, Brouwer, Swan, Bal)u Linking economic evaluations and health policy – delineation of thebasic benefits package (Brouwer, Koopmanschap, Redekop,Rijnsburger, Stolk, Van Baal)16

OUTCOMES RESEARCH: (COST-)EFFECTIVENESS OF (MEDICAL)TECHNOLOGIES IN DAILY PRACTICEu Studies on the cost-effectiveness of health technologies (emphasison expensive hospital drugs) in actual practice (Rutten, Uyl-de Groot)u Studies into differences in health, health care use and accessibilitybetween native Dutch and ethnic minority patients; cross-culturalvalidity of measurement instruments to assess health status(Agyemang, Denktaş, Foets)u Informal care: studying informal care, its impact on carers andcare recipients (Brouwer, Koopmanschap, Van Exel)u The role of databases in decision-making on the health carepackage (De Bont, Bal)u Studying the cost-effectiveness of complex interventions anddisease management (Rutten-van Mölken)HEALTH AND INCOMEu Economic studies in developing countries; Cost-effectiveness studies,burden-of- illness studies, and health insurance in developingcountries (Dror, Rutten, Uyl-de Groot, Van de Poel, Van Doorslaer)u Equity in the financing and delivery of health care in developingcountries (Van Doorslaer, O’Donnell, Van de Poel)u Income, health and work across the life cycle; trends in income andhealth inequality in Europe (Van Doorslaer, Van Ourti)u Economics of health behaviour and public health (Brouwer, Van Exel)u Migrant and Ethnic Health Observatory (MEHO) (Foets, Koopmans)u Health, labour and productivity (Hakkaart, Koopmanschap, Lötters,Severens)17

Since its foundation in 1982, socio-medical sciences have been one ofthe cornerstones of iBMG’s research and educational programmes.Under leadership of Professor Han Moll, a research group in sociomedicalsciences was given the responsibility to further develop thisfield of study.Research theme 2Under his successors, the research scope broadened from a dominantemphasis on the micro level of the patient, the health care providerand their interrelatedness to an additional focus on the populationlevel. Population health and its determinants, including the healthcare system, then became central issues. Currently, the socio-medicalresearch group is part of the research group Health Economics-iMTA.Main research topics of the socio-medical research group are:u health care use and access to health careu coping and social support processes in (chronic) diseaseu quality of careIn addition, some of the research has a more epidemiological focus.Recent research topics include occupational health and the relationbetween behavioural risk factors and health outcomes.The latter can be illustrated by the PhD project of Wim Labree,investigating parental behaviour and overweight in primary schoolchildren in the Netherlands.18

Logically, given this broad focus, the research and educationalprogrammes run by the socio-medical group are inherentlymultidisciplinary. The main scientific disciplines involved are (social)epidemiology, medical sociology and health psychology. Quite often,our research is closely intertwined with other disciplines that arerepresented within iBMG.Over the recent years, the socio-medical research group has developeda strong interest in disparities between the migrant and the nativeDutch populations, with respect to both access and quality of care indifferent settings such as primary care, mental health care, home careand antenatal care. Two PhD projects, of Semiha Denktaş and AnushkaChoté, are worth mentioning in this context. Both their defences areforeseen for 2011. Besides observational studies, experimental studieshave been conducted, aimed at evaluating interventions to improvethe access and quality of care for migrant groups. In cooperation withcolleagues at the Amsterdam Medical Centre the experience in thisfield has been documented in a textbook. An ongoing challenge is thestudy of which intermediating mechanisms (such as socio-economicposition) cause differences between migrant and native populations,as it is not the migrant background per se that is expected to createsuch disparities. Important mechanisms such as migration experiences,including discrimination, as well as cultural mechanisms and healthliteracy, are considered in this context.Socio-medical sciences“An ongoing challenge is the study of whichintermediating mechanisms (such as socioeconomicposition) cause differences betweenmigrant and native populations.”Marleen Foets, PhD19

Management and organisationof health care deliveryResearch theme 3The research in this theme is primarily carried out by the researchgroups Health Care Governance and Health Services Management &Organisation.QUALITY AND SAFETY OF HEALTH CARE DELIVERYu Patient safety in health care, e.g. primary care, mental health careand youth care (De Bont, Zuiderent-Jerak, Robben, Bal)u Effectiveness of monitoring the quality of health care (Robben)u Evaluation of “Care for Better”, the Dutch programme for long-termcare improvement (Nieboer, Strating, Zuiderent-Jerak, Stoopendaal,Bal)u Evaluation of a large-scale quality improvement programme for thetransition to adult care of young people with chronic conditions(Nieboer, Strating, Van Staa)u Geriatric Network Rotterdam and surroundings (GENERO), theprevention and reactivation care programme (Koopmanschap,Mackenbach, Nieboer, Van Wijngaarden)u Disease management: evaluation of programmes for COPD,neuropathic pain and 22 ZonMw practice projects (Cramm,Lemmens, Nieboer, Rutten-van Mölken, Huisman, Bal)u Quality and safety in European hospitals (Quaser) project (Bal,Weggelaar, Quartz)u Governing quality and safety in health care organisations (Bal,Øvretveit, Putters)u Evaluation of breakthrough projects oncollaborative thrombolytic care inacute stroke (PRACTISE)(Huijsman, Niesen,Van Wijngaarden)u Time Out Procedure(Dekkers- VanDoorn, Huijsman,Klein, VanWijngaarden)20

PROCESSES OF HEALTH CARE DELIVERYu Operations management and demand-based approaches to healthcare outcomes and cost-benefits research (Elkhuizen, Van deKlundert, Vissers)u Care pathways and logistics control; projects in the Rotterdam EyeHospital, treatment pathways in the Dutch Mental Health Care (GGZ),Jeroen Bosch Hospital and Catharina Hospital Eindhoven (Vissers,De Vries)u Efficiency improvement in the operating room by reducing variability(Vissers, De Vries, Stepaniak, Tweesteden Hospital)u Integrated bed- and staff-planning on different control levels(Vissers, De Vries, Berrevoets, UMC Radboud)u Integrated delivery systems in the care for the elderly (Fabbricotti,Huijsman, Meurs, Putters)u The organisation of integrated primary care (De Bont)u Integrated care in local networks; relationships between health caremanagement, local government and the creation of new alliancesand arrangements in delivering integrated care (Grit, Putters,Stoopendaal)u Improving the delivery of palliative care (Van de Klundert,Van Wijngaarden)HUMAN RESOURCE MANAGEMENTu Evaluation of the introduction of an outcome-based curriculum fortraining of medical specialists (De Bont, Meurs)u Interventions to improve team effectiveness (Klein, Van Wijngaarden)u HRM and team performance in health care (Buljac, Paauwe, Veld,Van Wijngaarden)u Service care chain (Van Wijk, Van Dijk, Paauwe)FINANCIAL MANAGEMENT IN HEALTH CARE DELIVERYu Measuring the potential of innovations and entrepreneurialopportunities (Van Ineveld, Klein, Van de Klundert)u Health care purchasing (Van Ineveld, Van de Klundert)21

INFORMATION AND COMMUNICATION TECHNOLOGYu Use of information technology in health care work; effectsof the implementation of ICT in health care work onprofessional relations within and between health careproviders, and effects of ICT on the flow of health carework and the quality and safety of health care (De Mul,Aarts, Bal, De Bont)u Health information technology and medicationsafety (Aarts, Bal)u Building and effects of care portals (Adams, Bal, De Mul)u Patients and the Internet: blogging, crowdsourcing andthe development of mobile health (Adams)u Use of digital outdoor clinics and new informationtechnologies in empowering patients and improvingthe cost-effectiveness of health care practices(MijnZorgNet) (Adams, Putters)u Reliability of information on the Internet; use of medicalinformation from the Internet and reliability of health careinformation on-line that is practically managed both bypatients and by (non) governmental initiatives (Adams, Bal,De Bont)METHODOLOGY OF MANAGEMENT AND ORGANISATIONSCIENCE IN HEALTH CAREu Evaluating complex interventions in health care (Bal, Nieboer)u Evaluating hospital performance during the Dutch care systemreforms (Van Ineveld, Van de Klundert, Van Oostrum, Steenhoek)u Understanding organisational development of hospitals (Muijsers,Scholten, Van de Klundert)22

Research theme 3The Institute of Health Policy & Management (iBMG) is one of theparticipants in a three-year project called Managed Outcomes, which isfinanced via the EU Seventh Framework Programme Health 2009.This project runs from January, 2010 to December, 2012. AaltoUniversity in Helsinki is the scientific coordinator of the project and theconsortium consists of 10 partners from 8 countries. The iBMG projectteam consists of Jan Vissers, Sylvia Elkhuizen, Mahdi Mahdavi and Jorisvan de Klundert.The assumption of Managed Outcomes is that demand-based andoperations management-based approaches in the regional delivery ofcare contribute to improved health outcomes and cost-benefits. This isoperationalised for four different cases: patients with diabetesmellitus type 2, patients with a stroke, patients with hip osteoarthritis,and patients admitted to hospital with dementia as co-morbidity. Theselection of cases is based on the expectation that innovative practicesfor these patients are required to meet the challenge of the increaseddemand for health care across Europe.In 2010, iBMG developed the methodology for the project. Wedeveloped an operational model to describe a regional network ofservice providers for a specific patient group in a standardised way.The operational model links demand to services, service journey,24

esources and costs. This standardised description of the managementof these primary operations is complemented with clinical data onoutcomes of processes and a survey among the users of the services ofthe regional delivery system. Based on this methodology, pilot studieshave been performed for the four selected patient groups. In thesepilot studies, quantitative models tailored to the patient groups havebeen developed to support data gathering and analysis in the nextsteps. Furthermore, iBMG has worked on the pilot case study fordiabetes. In this pilot we investigated the delivery of health services todiabetes type 2 patients in the region of Delft Westland Oostland andNieuwe Waterweg Noord. Following these pilots, 6 countries startedcollecting data for the four case studies for the selected patientgroups. In the Netherlands, the four case studies are carried outby iBMG.In 2011, comparison of the results from the four case studies acrossall six countries will make clear what best practice models can bedefined to meet the future health care challenges. The next stagewill be to discuss the findings of the case studies in both nationaland international workshops that will provide input for scenariodevelopment. The scenario analyses will provide more insight in towhat extent the best practice models will meet the future Europeanhealth care challenges.Managed outcomes“The assumption of Managed Outcomes is that demandbasedand operations management-based approachesin the regional delivery of care contribute to improvedhealth outcomes and cost-benefits.”Prof. Jan Vissers, PhD & Sylvia Elkhuizen, PhD25

Global health: spearheadin research and educationEllen van de Poel, PhD, assistant professor and researcherImproving population health and health equity in low- and middleincomecountries is a shared, international responsibility.In 2010, iBMG joined forces with the International Institute of SocialStudies (ISS) and the department of Public Health (MGZ) of Erasmus MCto organise the Diploma Course International Health & PolicyEvaluation (IHPE) for the first time.This 10-week programme was aimed at providing participants withthe essential training in health and health services research to supportrational decision-making and policy evaluation. Some of the maintopics of the Diploma Course were assessment of population health,evaluation of interventions and policies, cost-effectiveness analysis,priority setting, governance and equitable delivery and financing ofhealth services. Fourteen students, mostly mid-career professionalsfrom low- and middle-income countries, participated in the 2010course. On top of providing an exciting opportunity to contribute tocapacity building for improvements in global health, the DiplomaCourse strengthens connections in this field between the differentparticipating institutes.Research on health financing and health services is crucial to achieveimprovements in health in the developing world.The Diploma Course International Health & Policy Evaluation fitsseamlessly in a broader interest of iBMG to develop more researchand education programmes in the field of global health.Earlier in 2009, two large European Union funded research projects hadbeen assigned to iBMG, both aimed at evaluating health care financingreforms in Asia. The first, the Community Based Health Insurance (CBHI)project, aims to evaluate an innovative method of CBHI in India. Thesecond, the Health Equity and Financial Protection in Asia (HEFPA)project, evaluates the effects of recent large scale health care reformsthroughout six Asian countries.26

Part of the HEFPA projectis, for example, the impactevaluation of the NewCooperative Medical Schemethat has been rolled out inrural China.This scheme has been developed toinsure farmers against catastrophic costsof illness and to provide them better access tomedical care. Within HEFPA, researchers from iBMG,Shandong University and Oxford University are working togetherto design experiments that will allow successful evaluation of bothdemand and supply side interventions that are aimed at improving theprogramme’s impact on access to medical care and financial protection.In 2010, iBMG has also broadened its research-horizon to the Africancontinent, by establishing a partnership with ISS, the Africa StudyCenter, the Ethiopian Economics Association and Addis AbabaUniversity for a NWO funded project on evaluating CBHI in Ethiopia,and by collaborating with the Amsterdam Institute for InternationalDevelopment on evaluating insurance schemes in Kenya.The knowledge base generated by these projects will support policymakers who are facing the challenge of addressing major public healthproblems in the context of large financial and human resourceconstraints.27

Caring by dataAntoinette de Bont as a Harkness Fellow bij Kaiser PermanenteIn 2010, Antoinette de Bont was awarded a Harkness Fellowship forHealth Care Policy and Practice by the Commonwealth Foundation.Harkness fellows are appointed on the basis of achievement andpromise in health policy research. De Bont received this prestigiousfellowship to study the organisation of primary care.Antoinette de Bont is an associate professor in Health CareGovernance at the Institute of Health Policy & Management.Her primary focus in research has been on the changing roles ofprofessionals in health care organisations. De Bont studied howinformation technology shapes new possibilities for task delegationand how the use of administrative data for clinical governancereshapes the relation between professionals and insurers. Additionally,she studied how the introduction of an outcome-based curriculum formedical specialists affects the relationship between specialists athospitals on the one hand and their management on the other.Over the last two years, Antoinette de Bont focused her researchmainly on patient safety, as the shift from quality management tosafety management was hoped to be a new step towards clinicalgovernance. De Bont’s extensive research background at iBMG hascertainly proven its value during her period as a Harkness Fellow.The Harkness Fellowship offers mid-career health services researchersa unique opportunity to work with leading U.S. health policy experts.De Bont conducted her studies at Kaiser Permanente, an integrated“Both patients and physicians struggle with the shiftingboundaries between normal and abnormal”health care organisation in Oakland, California. In the summer of2009, just before the U.S. health insurance reform became into law,president Obama complimented Kaiser Permanente for its exemplaryrole on how health care can become affordable: “If we could actuallyget our health care system across the board to hit the efficiency levelsof a Kaiser Permanente (...), we actually would have solved ourproblems.” (Friedman, 2009, Times, July 30th). Dutch policy experts28

also see organisationssuch as Kaiser Permanenteas frontrunners in realisinga truly competitive healthcare market, in whichorganisations compete withregard to prices, but also serviceand quality. Moreover, for the Dutch,Kaiser Permanente is an outstandingexample of organising effective cooperationin primary care.At Kaiser Permanente, data management is the main guideline forthe provision of primary care. Since the introduction of an overallelectronic health record, the work of primary care providers hasgradually shifted from their consultation rooms to their offices. Onan average day a primary care physician can see 20 to 24 patients inperson and 80 patients electronically. In their offices, physicians checkand refill medications, answer email messages from patients and mostimportantly decide on the follow-up of test results. Moreover, labresults have become central in how care providers and patientsunderstand both disease and healthy living. An important question iswhether and under what circumstances the use of data is productiveor deceptive.“During my observation I have seen how both patients and physiciansstruggle with the shifting boundaries between normal and abnormal.It is the drugs – especially the direct costs and the possible side effects –that patients are supposed to take in, which makes both patients andphysicians feel uneasy. Yet, thanks to the widespread use ofantihypertentives, cholesterol-lowering drugs and antidiabetics,the number of deaths from cardiovascular diseases and stroke is –according to their own data – reduced by 30% at Kaiser Permamente.”In 2011 and 2012, Antoinette de Bont will further study the effectiveorganisation of primary care. With the experience gained at KaiserPermanente, she aims to contribute to the development of integratedand more powerful organisations in primary care.29

Erasmus-Columbus 2013André den Exter and Mahsa Ghari in PanamaIn 2010, André den Exter (assistant professor of Health Law) andMahsa Ghari (student of the bachelor Health Policy & Management),have been awarded an ERACOL scholarship. As result, both wereoffered the opportunity to spend some time at one of the partneruniversities in Panama.ERACOL (Erasmus-Columbus 2013) scholarships are intended to createmutual enrichment and better understanding between the EuropeanCommunity and Latin American countries. The target audience consistsof students and graduates from Colombia, Costa Rica and Panama andfrom European partner universities, who wish to spend a ‘mobility’ (i.e.exchange) period abroad for the purpose of participating in a study,training or research programme.André den Exter visited Panama City twice in 2010. At the LatinUniversity of Panama, he implemented a teaching programme andorganised a conference on Health Law. The teaching programmecovered a series of lectures on International Health Law and HeathEthics. Furthermore, Den Exter organised an international conferenceon Access to Health Care in the Latin American Region, aimed atexchanging ideas and formulating suggestions for improving (thepopulation’s) access to health care. The conference was open forboth health professionals and medical and/or law students, enablingboth groups to exchange their knowledge in the field of health care.Several topics were addressed including: the concept of international“Being outside my comfort zone in Panama has beeninfinitely valuable to me”health law, contemporary issues and the future of health law, humanrights and health care, genetics and health care rights, health careethics, and regulating clinical trials.Mahsa Ghari spent a full 7 months in Panama. At the faculty ofCriminology of the National University of Panama, she conductedresearch on the prevention and screening methods of Intimate PartnerViolence (IPV). IPV is a specialised form of domestic violence and amajor problem in Panama, mainly due to its machismo culture.Ghari experienced enormous cultural differences between European30

countries and Panama.Whereas in Europerigorous planning andbureaucratic formalities areinevitable, in Panama theLatin American flexibility andrelaxation hold the upper hand.At first Ghari had a hard time adjustingfrom the highly efficient and effectiveapproach to a less speedy one. Looking back, thefirst three months of inner conflict have actually been functional toher. This way she was given the chance to learn Spanish and focus onsocialising. After making new friends, discovering the country andexploring the Panamanian cuisine, Ghari was fully adapted to theenvironment, the people and the language. By then, her researchstarted making progress as well.IPV has been defined as physical, sexual and / or psychological harmwithin an intimate relationship. Women are most commonly victim ofthis type of violence. Worldwide, Panama occupies the 10th place withregard to violence against women. These women need medical careeither for themselves or for their children, in both of which casesmedical doctors (MDs) are the first to be informed about theirsuffering. Consequently, Ghari’s research was aimed at describing IPVscreening and screening-response among a sample of MDs in theemergency department. Results showed that only half of the MDsscreen for IPV.The main reasons for this were lack of resources and time to do so.Furthermore, it was found that there is great discrepancy betweenreceived training and expressed need for training on the matter of IPV.Finally, medical doctors were only little aware of policies and protocols.The conclusion of Ghari’s research was that more development withregard to the prevention of IPV is needed in Panama.For Mahsa Ghari, it has been a fabulous experience studying abroad.“Being outside my comfort zone and facing huge challenges on a dailybasis has been infinitely valuable to me. I believe that every studentshould at least spend six months of their college years abroad, tobecome resilient to the unpredictability of life after graduation.”31

3EducationProf. Roland Bal, PhD, director of educationHealth care issues have been given increasing attention in recent years.Newspapers are publishing reports on health care on a daily basis.The gradual introduction of market forcesstimulated by the government has stirredthe emotions and is expected to lead tomore efficient organisation of health care.At the same time, however, this might resultin financial difficulties for health careorganisations.Problems around quality and safety of care– such as ‘pyjama days’, preventable deathsin hospitals, or the use of isolation cells inmental health care organisations – arecommon now. Moreover, the health caresector should become more patient-orientedand should take greater account of possibleprevention measures.The organisation of health care is gaining incomplexity. The so-called ‘double greying’phenomenon (the disproportional rise inthe ageing population) causes an increasingdemand of health care. And the number ofpeople with a chronic disease is on the rise –mainly due to better chances of survival. Inaddition, we are witnessing a tendency tospecialisation, with all problems ofcoordination involved, and also more andmore complex medical technologies arebeing introduced that require organisationalchanges. The greater demand of health carealso has far-reaching consequences for thelabour market.Therefore, the health care sector is facing anumber of great challenges. We will needmany clever and well-educated people totake up these challenges. Of course we needmany health care professionals: doctors,nurses, and paramedics. But we also needmany people who have the skills to helporganise health care in a different way:managers who know all about the ins andouts of health care and who understand thelegal positions of patients, professionals and32

health care organisations. Managers whoare familiar with flows of funds in the healthcare sector, who realise how health careorganisations should be run, and who havegood insight into the sometimes complexrelationships between specialists and theirsuperiors. Managers who know how toefficiently organise care processes,supported by the newest informationtechnologies. But above all, we needmanagers who are creative enough and whodare coming up with new ideas in thesecomplex times, and who are well capable ofimplementing these ideas.In the past years iBMG has ventured intoeducating this very type of students, andwith success. Student numbers stronglyincreased over the report period: from 595students in September 2008 to 765 studentsin September 2010. It is gratifying to see thatthis rise is partly due to the higher numberof international students; over 30 in 2010.Moreover, graduated students will enter thelabour market relatively soon. Almost all willhave found jobs in health care within threemonths after graduation.In spite of the strong growth, we managedto sustain the quality of our education.Accreditation of the Dutch Bachelor ofScience in Health Policy & Management andthat of the Master of Science in HealthEconomics, Policy & Law (HEPL) proceededwithout a hitch. Accreditation of the DutchMaster of Science programme in Health CareManagement (Zoma) was postponed oneyear. In anticipation, effective measures havebeen taken to improve the quality of thethesis writing process and an HonoursProgramme was launched.The pass-rate of our programmes hasimproved over the years, although it still33

leaves something to be desired. Pass-rates(after four years) of the bachelorprogramme have reached 68% and thatof the Zoma master programme 65%(after two years). Only the HEPL masterprogramme, with a pass-rate of 23% (aftertwo years), remains a source of worry.For that matter, we aim to reach a pass-rateof at least 70% for all our programmes.In the coming years we will invest a greatdeal in stimulating measures, including theB1-project, which is aimed at improving(success-rates of) the BMG bachelorprogramme.Internationally iBMG has also unfoldedmore and more educational activities. Newcollaborations have been established withuniversities in Innsbruck (Austria) andAnkara (Turkey), as a result of which thenumber of exchange students has risen tosome 15 to 20 yearly. Furthermore, togetherwith the universities of Oslo (Norway),Innsbruck (Austria) and Bologna (Italy) weare busy setting-up an international jointmaster degree.Also, closer connections with Dutch Schoolsfor Higher Professional Education (hbo) havebeen established in the past years. A newpre-master programme was developed witha focus on lateral entry students: graduatesfrom a Dutch hbo or university who wishto do a master programme of iBMG.In consultation with Hogeschool Rotterdamwe are exploring whether a seamlesstransition from specific hbo-programmes toiBMG’s master programmes could perhapsbe achieved in due time.Although we have achieved a great deal,various challenges for the coming yearsremain. Apart from improving success-rateswe need to take measures to accommodatefor the ever growing numbers of students.This means that we will have to adjust, for34

example, the education facilitating processesand to equip the also rapidly growingteaching staff with required skills throughtraining courses and feedback.In addition, the growing diversity instudent body – in part due to the growingnumber of international students – requireseducational adaptations. As a matter ofcourse our education will have to keep trackof current developments in the health caresector.35

Bachelor Health Policy &ManagementAstrid van Keulen, MSc, education advisorThe bachelor programme in Health Policy & Management is doingwell. This may be concluded from the number of new students(around 160 new entries for 2010-2011), the 68% pass rate after4 years, the favourable programme reviews, and the convincinglyacquired re-accreditation.The years 2009 and 2010 have particularly been marked by there-accreditation of the bachelor programme. The self-evaluationreport was prepared in 2009 and the official visitation took place inApril 2010. Most importantly, the committee judged positively on theprogramme. The committee especially appreciated the structure ofthe curriculum, i.e. the build-up from monodisciplinary to multi- andinterdisciplinary courses, in combination with the academiccompetences programme.Naturally, the accreditation committee also suggested a number ofareas of special interest and made some recommendations to furtherimprove the curriculum. It was suggested to realise a more balanceddistribution of ECTS over the various courses, in particular for the firstyear; to find ways to reduce the relatively high drop-out rate in thefirst year; to improve students’ writing skills so as to increase thesisquality; and to evaluate why students perceive the first year’s studyload as light while at the same time many students are dropping out.These recommendations were largely in line with other initiativeswithin Erasmus University such as “Goed uit de Startblokken” and“Nominaal is Normaal” and other iBMG plans. In 2010, iBMGenergetically took up all recommendations and formed a workinggroup to commence curricular and extracurricular reforms, notably inthe first year of the bachelor programme. Several measures havealready been introduced in 2010, such as a compulsory languageproficiency test, an earlier start of tutoring, more attention toacademic writing skills, the set-up a digital student portfolio, andbetter harmonisation of courses in terms of assignments andadvancement of writing skills.36

This project will continuein 2011 under the name B1and will involve (larger)innovations in the bachelorprogramme, which willeventually lead to curricularreforms in the academic year2012-2013. These are some of thebasic principles: small-scale, activatingeducation programme with appropriatetesting methods, fewer competitive educationactivities, improving students’ writing and academic skills, reducingthe number of resits, distributing the number of ECTS more evenlyover all courses, and good supervision, both for students who needextra attention and for those who would welcome a greaterchallenge.In summary, we are proud that our bachelor programme was very wellappreciated externally; and in the years to come we will take up thechallenge to improve our education even more.37

Master Health CareManagementKees van Wijk, PhD, programme coordinatorIn many ways, the years 2009 and 2010 have been very exciting forthe master programme in Health Care Management. The number ofstudents has increased substantially, the curriculum was enrichedwith an extra course and various improvement projects havestarted.The substantial growth of student numbers continued through theyears 2009 and 2010. Of course we are delighted with this increase instudent numbers, but this has also led to increased pressure on theteaching methods of the master programme. Therefore, we chose torenew the curriculum at some points.The course Communication management (in Dutch) has been replacedby the new English course Health Service Supply Management. Thiscourse is provided in cooperation with the Rotterdam School ofManagement (RSM). To further improve the quality of the theses, weprolonged the thesis writing process by one month. A specialgraduation programme was set up for excellent students. Undersupervision of several professors, a select group of students works upto a publication of a scientific article in an English-language peerreview journal. Each year five students are selected for thisprogramme.Seven master students in Health Care Management participated in anexchange programme with the university of Oslo or Milano (Bocconi).Twenty-five students from both master programmes of iBMG took partin the yearly study trip to London. During this trip, these students gota good impression of the English health care system in comparison toour Dutch health care system.Furthermore, we have had some fine successes during the reportperiod. In both 2009 and 2010, the thesis award of the DutchAssociation of Managers in the Health Care (in Dutch: NVZD -Nederlandse Vereniging van Bestuurders in de Gezondheidszorg) waspresented to a student of our master programme in Health Care38

Management. In 2009Trudie van Duin won theaward for her research onperformance indicators inparamedic care. PatriciaHerber won the award in2010 for her research on theapplicability of care pathwayswithin health care organisations.The report period was particularlycharacterised by the assessment of all educationalprogrammes of iBMG. Partly based on our institutional auditreport, an external committee of experts judged the quality of ourmaster programme positively. The committee also provided usrecommendations to improve the balance between the scientificlevel of our master programme and its professional orientation.The concentration of all face-to-face education on one weekday, therelatively high number of students coming from a university of appliedsciences, the relatively limited amount of time students spend on theirstudy and the quality of the theses with lower marks were recognisedas points of improvement. Based on these issues, the AccreditationOrganisation of the Netherlands and Flanders (in Dutch: NVAO -Nederlands-Vlaamse Accreditatieorganisatie) decided not to fullyextend the accreditation of the master in Health Care Managementyet. At the end of 2011, the NVAO will reassess the level of theses inthe master programme and will then decide whether or not to fullyextend the accreditation.Within the master programme Health Care Management, we took therecommendations of the NVAO very seriously and immediately startedworking on implementing the renewals mentioned earlier. Ourchallenge is to raise the academic level of our master programmewithout risking losing its professional orientation. We gladly acceptthis challenge to further improve our master programme in HealthCare Management and we are confidently looking forward to the finalaccreditation assessment of the NVAO.39

Master Health Economics,Policy & LawJob van Exel, PhD, programme coordinatorThe iBMG master programme in Health Economics, Policy & Law(HEPL) had two very successful years.HEPL is attracting ever more students from all over the world. Thenumber of students enrolled in the programme has more thandoubled since 2008, to more than 120 students in 2010. In fairly equalproportions these students are from the iBMG bachelor programmeHealth Policy & Management, from other bachelor and masterprogrammes in the Netherlands, and from abroad.We are particularly proud of the increasing number of internationalstudents, coming to us from all continents. By contributing theirknowledge and local experience, and putting to discussion thechallenges their health care systems face, HEPL has truly become aninternational master programme.This growth in student population also made it possible to enrich theprogramme with a number of additional elective courses and two newspecialisations, alongside the established and successful specialisationin Health Economics, which we offer in co-operation with the ErasmusSchool of Economics since 2003. The new Pharmaceutical Marketspecialisation meets the interest from students and the industry forspecific training in pharmaceutical care issues. The Global Healthspecialisation, developed together with the Institute for Social Studiesin The Hague and the Department of Public Health of Erasmus MC inRotterdam, is attractive for students interested in the immensechallenges faced by health care systems in low and middle incomecountries. Both specialisations will run at the least for a pilot periodof three years (2011 - 2013).An important milestone for HEPL was the successful re-accreditation ofthe programme, the first since its start in 2003. The evaluation reportof the accreditation committee confirmed that HEPL offers highquality education and good employability to its graduates. But it alsopinpointed some important areas for improvement of the programme,most in particular concerning its effectiveness. The proportion of40

students graduating isgood, but the time ittakes them to graduate istoo long. Further analysis ofthe reasons for study delay,focussing first of all on the studyload of courses, the planning bystudents and the clarity and qualityof our procedures and communication,is currently taking place.We are also working on strengthening our international network.We already offered our students various exchange opportunities withuniversities across Europe, like Oslo and Milan, and regularly hostedrenowned guest speakers. We are now studying the possibility todevelop an international joint degree programme.For two years now, HEPL is present on the main social and professionalnetwork sites, facilitating communication between students andgraduates, and creating opportunities to stay or get in touch withpeers, academic staff, and potential employers and employees.All in all, HEPL has changed considerably in many ways over the pasttwo years. Thanks to the experienced and renowned academicteaching staff, we have at the same time managed to continue beingan attractive, challenging programme, offering students high qualityeducation and good employability after graduation.41

Post-academic education:Erasmus CMDzProf. Pauline Meurs, PhD & Wilma van der Scheer, MSc,directorsThe years 2009 and 2010 were successful and rewarding years forErasmus Centre for Management Development in health care(Erasmus CMDz). Despite the general crisis and several cutbacks inhealth care budgets, Erasmus CMDz has been able to secure its solidmarket position.The Master of Health Business Administration, an internationallyaccredited two-year master programme that focuses on strategyand business administration of health care organisations, started inSeptember 2010 with a new group of 22 meticulously selectedparticipants. Earlier, in June, all participants of the class 2008-2010had been awarded their diploma.The Master Class – which earned Erasmus CMDz its good reputation –is our longest running programme. It provides a state-of-the-artoverview of developments in health policy and management andthere is ample room for exchange of experiences. In 2010, a group of22 participants started the Master Class, whereas 18 participantsreceived their certificate for successfully completing the programme.With its ever improving reputation, the Top Class for prospectivemanaging directors has once again drawn an overwhelming interest in2010. Several applicants had to be placed on a waiting list.Yearly, only 22 or 23 carefully selected health caremanagers and professionals from differentsectors are admitted to the one-yearprogramme.The Academic Course in HealthCare Management is aimed atexpanding and improving theknowledge and professionalskills of managers and policymakers in the health care sector.Gradually gaining a betterreputation, the Academic42

Course was organised forthe third time in 2010.Furthermore, Erasmus CMDzoffers several programmes,specifically designed forconnoisseurs. For example, theCourse in Financial Management inHealth Care has been organised twice in2010. Also, we had 17 experienced managersgraduate from our programme Values of HealthCare in 2009.In close cooperation with several social partners, Erasmus CMDz hasalso developed the European Health Leaders Programme (EUHLP).This programme has been specifically designed to meet the needs oftop leaders in European health and social care systems. EUHLP is acooperation between Durham University (England), National Schoolof Public Health Madrid (Spain), Karolinska Institute (Sweden),Semmelweis University (Hongary) and Erasmus CMDz. Lack of interest,however, made us decide to postpone the programme for the timebeing.In 2010, Erasmus CMDz invested in international partnerships todevelop new European study trips for the MHBA and Master Class,to take the Top Class to Brussels and to develop EUHLP. Other capitalinvestments have been made in favour of research on governance ofhealth care organisations, career opportunities and issues regardingsuccession of health care executives.43

Academy forMedical SpecialistsPieter Wijnsma, MD, Director Academy MSSince 2008, iBMG participates in the Academy for MedicalSpecialists, together with the Order of Medical Specialists andVvAA, an insurance and service organisation for (para)medics.The Academy provides courses for medical specialists and residents,which are offered to individuals and as in-company training. Thecourses encompass topics such as medical management, hospitalmanagement, health economics, quality and safety and skills, suchas cooperation, conflict management, negotiation, stress and timemanagement, effective chairing of meetings and so on. Since itsfoundation in 2008, the output of the Academy has more thandoubled. At the end of 2010, the Academy was well known amongmedical specialists, organisations of medical specialists, hospitals andmental health institutes.In 2009, the Academy organised 57 courses (107,5 training days)for 673 participants. In 2010, the Academy provided 80 courses(167 training days) for 1051 participants.Among the courses in 2010 were 15 courses of 2 days each on MultiSource Feedback (MSF) for auditors. The Order of Medical Specialistsadvises all medical staff to implement a system of job evaluationconversations and advises them to use either MSF or Appraisal &Assessment (A&A). Auditors are trained to lead those conversations.Auditors in one-third of all hospitals are trained by the Academy.The Academy also trains audit committees of nationalassociations of medical specialists, who perform audits ofgroups of staff in a hospital. The Academy has alsoorganised 4 regional conferences for 222 medicalspecialists on behalf of the national associations ofanaesthesiologists and surgeons on the topic ofimplementation of guidelines for the preoperativeprocess. The Health Care Inspectorate has made theimplementation of these guidelines mandatory.44

Since 2009, the Academyprovides yearly courses onmedical management forclinical residents uponrequest of two academichospitals and two nationalassociations of medical specialists.These vary from 2 to 6 days each. In2010, 225 residents were reached thisway. The largest part of all training isprovided to medical specialists with a part time roleas medical manager of a department in a hospital and to boardmembers of the associations of medical staff, which exist in all generalhospitals. They are trained in ‘hard’ and ‘soft’ aspects of management,either in courses on a national level or on the spot for groups ofmedical managers or the board of an association of medical staff inspecific hospitals.45

Two thesis prizes for studentHealth Care ManagementPatricia Herber achieves double success with her master thesisIn 2009, Patricia Herber was not only the recipient of thethesis prize for students of the iBMG master programme inHealth Care Management but also of the thesis prize awardedby the Dutch Association of Health Care Executives (NVZD) forher thesis “Voorzorg voor zorgpaden”(clinical paths precautions).The thesis was prepared under supervision of Sylvia Elkhuizen, PhDand Prof. Jan Vissers, PhD (second assessor).The subtitle of the thesis – “a search for factors that play a role inassessing whether the clinical path method is of added value to andcompatible with an organisation” – clearly explains the contents ofthe thesis. Many health care institutions are developing clinical pathsthat would help organise the care processes of certain patient groupsand to harmonise these with the hospital organisation. However, theprerequisites that should be met for successful implementation ofclinical paths are not always paid attention to.On the basis of a literature search Patricia compiled a list ofprospective indicators that enable an organisation to assess whetherclinical paths are of added value to and compatible with theorganisation. To structure the many indicators found, Patriciadistinguished between basic principles, pre-conditions,and influences and consequences. Basic principles inthis study are the principles that underlie demanddrivencare, such as a mission, vision andorganisational aims that depart fromdemand-driven care. Pre-conditionsnotably determine the chance ofsuccessful implementation of clinicalpaths. They include the availability ofmarket information, ICT-potentialsand the extent to time-slots can beagreed upon. Lastly, influencesand consequences are principlesrelating to organisationalfactors that should be takeninto account. Thus the

developments in thecompensation system inthe health care sector mayhave consequences forclinical paths, and a hospital’sbasic structure may influencethe organisation of clinical paths.The model was tested and expandedbased on the experience gained in thedepartment of Neurology in the St. AntoniusHospital, Utrecht.Patricia Herber found a total of 32 factors that influence theorganisation of clinical paths. Every organisation or department that isconsidering implementing clinical paths should address the followingquestions in relation to each of these indicators:u To what extent does this factor play a role within my organisationor department?u What activities should my organisation or department employ toensure that this factor does not impede the organisation of clinicalpaths?By addressing these questions an organisation will be better facilitatedto assess whether clinical paths have added value and are feasible withthe organisation. The list of factors has been transposed into aquestionnaire, which offers organisations a handy tool to assess theissues of added value and feasibility.By linking theory and practice, Patricia Herber conferred both scientificand practical value on her work. This well-written and nicely designedthesis is the result of a huge body of work. A scientific paper based onthe findings of this research is being prepared.47

4ManagementaffairsMarieke Veenstra, MSc, Managing directorIn line with developments in the previous report period, iBMG flourished again in2009 and 2010. To further boost the educational and research programmes weinvested in more personnel.CONTINUED GROWTHNotably the number of PhD-students hasrisen considerably, but we have alsoinvested in top researchers – witness theappointments of three new professors andthree new associate professors. iBMG is anenterprising institute with a host ofcollaborations and room for young talent.More than half of its turnover comes fromprojects commissioned by theNetherlands Organisation forScientific Research (NWO),the NetherlandsOrganisation forHealth Research andDevelopment(ZonMw), theEuropean Union,or other externalprincipals.REUNITED IN A NEW SETTINGThe continuous growth of our Institute wasreason to move our headquarters to anotherbuilding on campus Woudestein. Movingfrom the L-building to the J-building had tobe done in three steps, and this is why thewhole procedure took over three years.Although a radical change, this move hasbrought us many good things. An interiorarchitect helped create anambiance that fits theInstitute’s ambitions.The building has theright image andinspires both staffand visitors.Care was taken toprovide enoughspaces where ourstaff can meetand exchange48

knowledge. Apart from the office roomsmany shared facilities have been created,radiating a domestic atmosphere.Completion of the relocation process wascelebrated in October 2010 with a grandparty for all staff and their partners.Not long thereafter we welcomed in ourbuilding 200 former students of ourprogrammes at a seminar-evening for alumniunder the name ‘Zorg voor Kennis’ (Care forKnowledge). Our alumni were veryenthusiastic about the mixture of beingreacquainted with iBMG and with eachanother, and attending seminars jointlypresented by an academic staff memberand an alumnus.IBMG SCULPTUREThe staff party in October 2010 also saw theunveiling of the ‘iBMG sculpture’ designedby Ad Haring. Since then all master studentsreceived upon graduation a miniature modelof this sculpture. It also serves as a farewellgift for iBMG staff upon termination ofemployment. The sculpture symbolicallyrepresents various characteristics of iBMG.At the basis stands the figure of DesideriusErasmus. He is flanked on all sides by cubeshapes that symbolise the multidisciplinarynature and the versatility of researchconducted at iBMG. The build-up of the cubicshapes furthermore is suggestive of thepersonal growth and inquisitivenessobserved in our students and staff. Thecubic shape at the top is transparent as asymbol of the open mind. The side ofErasmus’s head which is visible through thetransparent shape is purple-coloured in linewith the colour purple typical for iBMG.The golden lustre accentuates Erasmus’sfigure and symbolises iBMG’s unique andprominent position in society and notablyin the health care sector.49

RETURN TO ERASMUS UNIVERSITYROTTERDAMBy the end of 2008 it was decided thatiBMG would return to Erasmus UniversityRotterdam. This administrative transfer tookplace on 1 January 2010. From that date allpersonnel was now employed by ErasmusUniversity Rotterdam (EUR) instead ofErasmus MC. Financial management wasmigrated as well, and all arrangements werelaid down in an asset/liabilities agreement.Our Institute is now functioning as a facultyof Erasmus University and this was specifiedin a BMG regulations document and amanagement guide. To allow for studentand employee participation the BMG-councilcame into being; with four student membersand four staff members the council functionsas a faculty council. The first electionsalready excited much enthusiasm bothamong students and staff. We can rightly saythat iBMG’s management team has beenenriched with a valuable advising party.RESEARCH COOPERATIONiBMG is dedicated to strengthen its researchcooperations with both Erasmus MC and theother EUR faculties. Effective collaborationshave been established in the fields of healtheconomics, health care logistics, patientsafety and health law. Other possiblecollaborations in the fields of global health,social sciences and business administrationwith regard to the health domain have beenand are actively explored. The joint objectiveis to create a strong centre of expertise onhealth policy and management inRotterdam. We will naturally continue topursue all these ambitions in the comingyears as well.50

5Facts and figuresEducation2008-2009 2009-2010 2010-2011Number of studentsInternational studentsBachelor 1 150 165 160Bachelor 2 96 90 80Bachelor 3 60 80 80Pre-master 121 150 160MSc Zoma 113 115 163MSc HEPL 55 60 122595 660 7652008-2009 :13 28 2009-2010 : 332010-2011 :52

ResearchNumber ofinaugural lecturesNumber ofPhD defences2009 :42010 :22009 :82010 :7Management affairsStaff (FTE)2009 :140,2 2010 : 158,753

6StaffxxxRESEARCH GROUP HEALTH ECONOMICS-IMTAResearch group leaderF.F.H. Rutten (2009), W.B.F. Brouwer (2010)M.J. Al, A.E. Attema, P.H.M. van Baal, S.A. Baeten, P.L.H. Bakx, H. Binnendijk, E. Birnie,H. Bleichrodt, H.M. Blommestein, A. Bobinac, M.R.S. Boland, I.E.J. Bonfrer, G.J. Bonsel,C.A.M Bouwmans, L.T. Burgers, A.A. Choté, I. Corro Ramos, E.K.A. van Doorslaer,N.J.A. van Exel, M. Filko, M.G. Flores Pentzke, M. Foets, M.G. Franken, J.G. Gaultney,C.W.M. van Gils, L.M.A. Goossens, S. de Groot, J.A. Haagsma, L. Hakkaart- van Roijen,R.J. Hoefman, K.M. Holtzer-Goor, E.J.I. Hoogendoorn-Lips, T.A. Kanters, M.A. Kiel,C. Koedoot, G.T. Koopmans, M.A. Koopmanschap, H.M. Krol, L.J.W. Labree, A. Leunis,Y. Li, F.J.B. Lötters, C.A.M. de Meijer, L.M. Niëns, M. Oppe, E. van de Poel, M.J. Poleij,D.R. Rappange, W.K. Redekop, A.J. Rijnsburger, E.M. van Rooijen, M.P.M.H. Rutten-vanMölken, S.J. Schawo, J.L. Severens, H.M. Sonneveld, E.A. Stolk, S.S. Tan, A. Tsiachristas,C.A. Uyl-de Groot, P. Vemer, M.M. Versteegh, A. de Vries, E.J. van de Wetering54

RESEARCH GROUP LAW & HEALTHCARERESEARCH GROUP HEALTHCARE GOVERNANCEResearch group leaderM.A.J.M. BuijsenA.P. den Exter, O.A.M. Floris, H.E.G.M.Hermans, E.H. Hulst, E.M.H. Loozen,B. Megens, T.J.C. van Noord, M. San Giorgi,G.E. van der Spoel, S.P. ZinzombeResearch group leaderR.A. BalJ.E.C.M. Aarts, S.A. Adams, L. Behr,M.P.M. Bekker, A.A. de Bont, H.M. vande Bovenkamp, E. den Breejen,J. Dwarswaard-de Snoo, C. van Egmond,J. van Ellinkhuizen, K.J. Grit, B.J.A. Walters-Hipple, E. Huisman, M. Janssen, S. Jerak,E. van Loon, P.L. Meurs, M.G.H. Niezen,W.R.F. Notten, L. E. Oldenhof, K.T. Paul,H. Pirnejad, K. Putters, J.G.U. Quartz,A.L. van Staa, A.M.V. Stoopendaal, A.A.W.M.van de Veerdonk, F.D. Vennik, J.A. Verhulst,I. Wallenburg, R.L.E. Wehrens, T. Zuiderent.55

xxxRESEARCH GROUP HEALTHINSURANCEResearch group leaderW.P.M.M. van de VenL.H.H.M. Boonen, F. Eijkenaar, S.A. van derGeest, R.C. van Kleef, T. Laske-Aldershof,A.F. Roos, F.T. Schut, M. Varkevisser,R.C.J.A. van VlietRESEARCH GROUP HEALTH SERVICESMANAGEMENT & ORGANISATIONResearch group leaderJ.J. van de KlundertM.J.C. Aspria, C.T. Boon, J.J.C. van den Broek,T. Broer, M. Buljac, J.M. Cramm, C.M. DekkervanDoorn, A.J.A Donkers, S.G. Elkhuizen,I.N. Fabbricotti, R.S. van der Gaag,J.J.M.Geelhoed, M.A. Goossensen, M.L.Hagenbeek, J.M. Hartgerink, R. Huijsman,B.M. van Ineveld, B. Janse, J. Klein, D.F. deKorne, K.M.M. Lemmens, H. Machielsen,M. Mahdavi, P. Makai, B. van der Meij,J.J. Morsinkhof, L. Muijsers, M. de Mul,A.P. Nieboer, K.J. Nijmeijer, V.C. Pijpers,G.R.M. Scholten, S.S. Slaghuis, H.M. Sonne -veld, M.M.H. Strating, E. Suurland, R.B. Teng,M.F.A. Veld, J.M.H. Vissers, G. de Vries,J.W.M. Weggelaar, E.J. van de Wetering,K.P. van Wijk, J.D.H. van Wijngaarden56

SUPPORT OFFICEM. Ajroud, E.P. Bakker, M. Brouns, S.P.A. Bus,A.A.A. Buysse, A. Dijkhoff, M.E. van derDoes, B.Y. Froling, S. Groen, P.C. Heepke,G.M. van Heteren, I.M. van der Horst,W.A.A. Jaspar, A.M. Jonker, M.S. Kelder,A.P. van Keulen, K.E. de Klerk-Regt,J. Klomps, S.A.E. Konings, C. Kool, L.J.W.Labree, Y. Lengkeek, S. Meeuwsen, J.T.Meijer, D. Mevius, R. Molijn, A. Morais,L.M. Moreira, J.G. Muilenburg-Have, M.C.A.Muilenburg, K.C.H. van Oorschot, E. Pelit,E.B. Ritfeld, E. van der Schee-van Driel,M.K. Sieverts, E.D. Schoen, B. Schotpoort,I. Sjoerdsma, E.M. Sophia, R. Speek,B.A. Thiels, M.S. Veenstra, W.A.G.Verhoeven, M. Verschoor, M.M. Verschuren,W. Visser-Steinvoort, A.J. Wagner, K.P.M.van Winssen, S.S. Woelms, A.C. Zwaan.GUEST LECTURERS AND RESEARCHERS/ EXTERNAL PHD STUDENTSJ.C. Bouvy, J.D.C. Brugma, D.M. Dror, J. deGoede, T.L. Goffin, T.E.D. van der Grinten,R.M.C. Herings, R.J. de Koeijer, R.J.P.Kottenhagen, J.J. Luime, T.J. Malmström,Z. Niazkhani, M.P.M. Nuijten, J.M. vanOostrum, J. Paauwe, T.J. Pels, J.P. Postma,M. Quintussi, S.I. Rutz, N.A.F.M. Schreiner,P.J.A. Stam, K.M. van Steenbergen,A. Steenhoek, Y. Taghipour Bazargani,T.S.M. van der Velde, C. de Vos, J.P. Weemers,A.C.M. Winters, W. Xu57

7 AcademicPublicationsPlease turn this report over tothe Dutch-language side andbrowse to page 60 to get anoverview of all academicpublications of the Institute ofHealth Policy & Managementin the years 2009 and 2010.59

7WetenschappelijkepublicatiesAcademicpublicationsOnderzoeksthema 1: Marktordening enstelselinrichting in de gezondheidszorgResearch theme 1: Competition andregulation in health carePROEFSCHRIFTPhD-THESISBoonen, L.H.H.M. (2009). Consumer channeling in health care:(im)possible? Promotor: prof.dr. F.T. Schut.Bovenkamp, H.M. van de (2010). The limits of patient power. Examiningactive citizenship in Dutch health care. Promotor: prof.dr. M.J. Trappenburg.Jeurissen, P.P.T. (2010). For-profit hospitals. A comparative and longitudinalstudy of the for-profit hospital sector in four Western countries.Promotor: prof.dr. T.E.D. van der Grinten. Copromotor: prof.dr. F.T. Schut.Kleef, R.C. van (2009). Voluntary Deductibles and Risk Equalization:A complex interaction. Promotor: prof.dr. W.P.M.M. van de Ven.Copromotor: dr. R.C.J.A. van Vliet.Varkevisser, M. (2009). Patient Choice, Competition and AntitrustEnforcement in Dutch Hospital Markets. Promotor: prof.dr. F.T. Schut.60

WETENSCHAPPELIJK ARTIKEL / BRIEF AAN DE REDACTIESCIENTIFIC ARTICLE / LETTER TO THE EDITORAdams, S.A. & Bal, R.A. (2009). Practicing Reliability: ReconstructingTraditional Boundaries in the Gray areas of Health information reviewon the web. Science, Technology & Human Values, 34, 34-54.Armstrong, J., Paolucci, F. & Ven, W.P.M.M. van de (2010). Risk equali -sation in voluntary health insurance markets. Health Policy, 98, 1-2.Armstrong, J., Paolucci, F., McLeod, H.L. & Ven, W.P.M.M. van de (2010).Risk equalisation in voluntary health insurance markets: A threecountry comparison. Health Policy, 98, 39-49.Arrow, K., Auerbach, A.D., Bertko, J., Brownlee, S., Casalino, L.P.,Cooper, J., Crosson, F.J., Enthoven, A.C., Falcone, E., Feldman, R.C.,Fuchs, V.R., Garber, A.M., Gold, M.R., Goldman, D., Hadfield, G.K., Hall,M.A., Horwitz, R.I., Hooven, M., Jacobson, P.D., Jost, T.S., Kotlikoff, L.J.,Levin, J., Levine, S., Levy, R., Linscott, K., Luft, H., Mashal, R.,McFadden, D., Mechanic, D., Meltzer, D., Newhouse, J.P., Noll, R.G.,Pietzsch, J.B., Pizzo, P., Reischauer, R.D., Rosenbaum, S., Sage, W.,Schaeffer, L.D., Sheen, E., Silber, M., Skinner, J., Shortell, S.M., Thier,S.O., Tunis, S., Wulsin, L., Yock, P., Bin Nun, G., Stirling, B., Luxemburg,O. & Ven, W.P.M.M. van de (2009). Toward a 21st-Century health caresystem: recommendations for health care reform. Annals of InternalMedicine, 150, 493-495.61

Bekker, M.P.M., Egmond, C. van, Wehrens, R.L.E., Putters, K. & Bal, R.A.(2010). Linking research and policy in Dutch healthcare: infrastructure,innovations and impacts. Evidence & Policy, 6(2), 237-253.Bettendorf, L., Geest, S.A. van der & Kuper, G.H. (2009). Do daily retailgasoline prices adjust asymmetrically? Journal of Applied Statistics,36(4), 385-397.Bevan, G. & Ven, W.P.M.M. van de (2010). Choice of providers andmutual healthcare purchasers: can the English National Health Servicelearn from the Dutch reforms? Health Economics, Policy and Law, 5,343-363.Boonen, L.H.H.M., Donkers, B. & Schut, F.T. (2010). Channelingconsumers to preferred providers and the impact of status-quo bias:does type of provider matter? Health Services Research, accepted.Boonen, L.H.H.M., Schut, F.T., Donkers, B. & Koolman, A.H.E. (2009).Which preferred providers are really preferred? Effectiveness ofinsurers' channeling incentives on pharmacy choice. InternationalJournal of Health Care Finance and Economics, 9(4), 347-366.Bovenkamp, H.M. van de (2009). Creating citizen-consumers: changingpublics and changing public services. Acta Politica. Tijdschrift voorPoliticologie, 44, 459-462.Bovenkamp, H.M. van de & Trappenburg, M.J. (2009). ReconsideringPatient Participation in Guideline Development. Health Care Analysis,17, 198-216.Bovenkamp, H.M. van de, Trappenburg, M.J. & Grit, K.J. (2010). Patientparticipation in collective healthcare decision making: the Dutchmodel. Health Expectations, 13, 73-85.Bovenkamp, H.M. van de & Trappenburg, M.J. (2010). The relationshipbetween mental health workers and family members. PatientEducation and Counseling, 80, 120-125.Dixon, A.K., Robertson, R. & Bal, R.A. (2010). The experience of imple -menting choice at point of referral: a comparison of the Netherlandsand England. Health Economics Policy and Law, (5), 295-317.Egmond, C. van & Zeiss, R. (2010). Modeling for Policy. Science-basedmodels as perfomative boundary objects for Dutch policy making.Science Studies, 23(1), 58-78.Exter, A.P. den (2009). Chronically mentally ill people, and the neglectand abuse they experience, have become increasingly invisible. Lancet,374(9690), 599-600.Exter, A.P. den (2009). PharmaNostra Under Fire. Croatian MedicalJournal, 50, 507-508.62

Exter, A.P. den (2010). Health System Reforms in The Netherlands:From Public to Private and its Effects on Equal Access to Health Care.European Journal of Health Law, 17, 223-233.Jedeloo, S., Staa, A.L. van, Latour, J.M. & Exel, N.J.A. van (2010).Preferences for health care and self-management among Dutchadolescents with chronic conditions: A Q-methodologicalinvestigation. International Journal of Nursing Studies, 47, 593-603.Kleef, R.C. van, Ven, W.P.M.M. van de & Vliet, R.C.J.A. van (2009).Shifted deductibles for high risks: More effective in reducing moralhazard than traditional deductibles. Journal of Health Economics, 28,198-209.Kleef, R.C. van, Beck, K. & Buchner, F. (2010). Risk-Type Concentrationand Efficiency Incentives: A Challenge for the Risk AdjustmentFormula. The Geneva Papers, 35, 503-520.Loozen, E.M.H. (2010). The workings of article 101 TFEU in case of anagreement that aims to limit parallel trade (GlaxoSmithKline Services(C-501/06 P, C-513/06P, C-515/06 P and C-519/06 P). EuropeanCompetition Law Review, 9, 349-353.Paolucci, F., Prinsze, F.J., Stam, P.J.A. & Ven, W.P.M.M. van de (2009).The potential premium range of risk-rating in competitive markets forsupplementary health insurance. International Journal of Health CareFinance and Economics, 9, 243-258.Pollitt, C., Harrison, S., Dowswell, G., Jerak, S. & Bal, R.A. (2009).Performance Regimes in Health Care: Institutions, Critical Juncturesand the Logic of Escalation in England and the Netherlands.Evaluation, 16, 13-29.Schut, F.T. & Berg, B. van den (2010). La sostenibilità del sistema diassicurazione universale per il long-term care nei Paesi Bassi. PoliticheSanitarie, 11(2), 98-112.Schut, F.T. & Berg, B. van den (2010). Sustainability of ComprehensiveUniversal Long-term Care Insurance in the Netherlands. Social Policy &Administration, 44(4), 411-435.Stam, P.J.A., Vliet, R.C.J.A. van & Ven, W.P.M.M. van de (2010). Alimited-sample benchmark approach to assess and improve theperformance of risk equalization models. Journal of Health Economics,29, 426-437.Stam, P.J.A., Vliet, R.C.J.A. van & Ven, W.P.M.M. van de (2010).Diagnostic, Pharmacy-Based, and Self-Reported Health Measures inRisk Equalization Models. Medical Care, 48(5), 448-455.Swierstra, T., Bovenkamp, H.M. van de & Trappenburg, M.J. (2010).Forging a fit between technology and morality: The Dutch debate onorgan transplants. Technology in Society, 32, 55-64.63

Varkevisser, M., Geest, S.A. van der & Schut, F.T. (2009). Assessinghospital competition when prices don't matter to patients: the useof time-elasticities. International Journal of Health Care Finance andEconomics, 10(1), 43-60.Ven, W.P.M.M. van de & Schut, F.T. (2009). Managed competition in theNetherlands: still work-in-progress. Health Economics, 18, 253-255.Wehrens, R.L.E., Bekker, M.P.M. & Bal, R.A. (2010). The construction ofevidence-based local health policy through partnerships: Researchinfrastructure, process and context in the Rotterdam 'Healthy in theCity' programme. Journal of Public Health Policy, 31(4), 447-460.Xu, W. & Ven, W.P.M.M. van de (2009). Purchasing health care in China:Competing or non-competing third-party purchasers? Health Policy,92, 305-312.Zuiderent, T. (2009). Competition in the wild: ReconfiguringHealthcare Markets. Social Studies of Science, 39(5), 765-792.BOEK(HOOFDSTUK)BOOK(CHAPTER)Adams, S.A. (2010). Sourcing the Crowd for Health Experiences:Letting the People Speak of Obliging Voice Through Choice? In R.Harris, N. Wathen & S. Wyatt (Eds.), Configuring Health ConsumersHealth Work and the Imperative of Personal Responsibility (SeriesStanding Order) (pp. 179/12-193/12). Basingstoke: Palgrave Macmillan.Buijsen, M.A.J.M. & Akveld, J.E.M. (2010). Bijzondere patiëntenrechtenin de gezondheidszorg. In H.E.G.M Hermans & M.A.J.M Buijsen (Eds.),Recht en Gezondheidszorg (pp. 259-304). Maarssen: Elsevier.Buijsen, M.A.J.M. (2010). Rechtshandhaving in de gezondheidszorg. InH.E.G.M Hermans & M.A.J.M Buijsen (Eds.), Recht en Gezondheidszorg(pp. 593). Maarssen: Elsevier.Boonen, L.H.H.M., Geest, S.A. van der, Schut, F.T. & Varkevisser, M.(2010). Pharmaceutical Policy in the Netherlands: from price regulationtowards managed competition. In Pharmaceutical markets andInsurance Worldwide (Advances in Health Economics and HealthServices Research, 22) (pp. 53). Bingley: Emerald Group PublishingLimited.Exter, A.P. den (2009). Chapter IV: Equality and the Right to HealthCare. In A.P. den Exter & M.A.J.M. Buijsen (Eds.), Human Rights andBiomedicine (pp. 69-86). Antwerpen/Apeldoorn/Portland:Maklu&Authors.Exter, A.P. den (2009). Introduction: The Biomedicine Convention.In A.P. den Exter (Ed.), Human Rights and Biomedicine (pp. 9-21).Antwerpen/Apeldoorn/Portland: Maklu&Authors.64

Hermans, H.E.G.M. & Buijsen, M.A.J.M. (2010). Recht en Gezond heids -zorg. Amsterdam: Elsevier Gezondheidszorg.Noord, T.J.C. van (2010). Wet- en regelgeving in de zorg(Preventiewetgeving en wetgeving publieke gezondheidszorg, 12).Eindhoven: SBO.Noord, T.J.C. van (2010). Openbare gezondheid en preventie. InH.E.G.M. Hermans & M.A.J.M Buijsen (Eds.), Recht en gezondheidszorg(pp. 461). Maarssen: Elsevier.Noord, T.J.C. van (2010). Preventiewetgeving en wetgeving openbaregezondheidszorg. In M.A.J.M. Buijsen & H.E.G.M. Hermans (Eds.), Wetenregelgeving in de zorg (pp. 5/12-49/12). Euroforum.Schut, F.T. & Varkevisser, M. (2009). Marktordening in degezondheidszorg. In F.T. Schut & F.F.H. Rutten (Eds.), Economie van degezondheidszorg (pp. 247-288). Maarssen: Elsevier Gezondheidszorg.Schut, F.T. & Kam, C.A. de (2010). Het budgettaire zorgenkind. In C.A.de Kam, J.H.M Donders & A.P. Ros (Eds.), Miljardendans in Den Haag(pp. 89-6). Den Haag: SDU Uitgevers.Trappenburg, M.J., Schillemans, T. & Bovenkamp, H.M. van de (2009).Cliëntenraden en klantenfora. In M. Bovens & T. Schillemans (Eds.),Handboek publieke verantwoording (pp. 10). Den Haag: Lemma.Varkevisser, M. & Schut, F.T. (2010). Ziekenhuisfusies en concurrentiein het Nederlandse zorgstelsel (SMO Publicaties 2009, 5/6). Den Haag:SMO - Stichting Maatschappij en Onderneming.VAKPUBLICATIEARTICLE IN DUTCH JOURNALBal, R.A. (2009). Patiënten 'in onderzoek': een stap verder dan hetRGO-advies. TSG, 87(8), 334-335.Boonen, L.H.H.M. & Schut, F.T. (2009). Zorgverzekeraars kampen metvertrouwensprobleem. Economisch-Statistische Berichten, 94(4572),678-681.Bovenkamp, H.M. van de & Trappenburg, M.J. (2009). De moeizamerelatie tussen hulpverleners en familieleden in de GGZ. MGV, 64(1-2),27-38.Breejen, E. den & Putters, K. (2009). Voorwaarden voorinnovatiekracht. Zorgmarkt, 5, 27-29.Buijsen, M.A.J.M. (2010). De bijzondere morele status vangezondheidszorg. Over marktwerking, gelijke behandeling en denoodzaak van zeggenschap. Filosofie en Praktijk, 31(3), 51-64.65

Exter, A.P. den (2009). Apothekerverband. DocMorris en het Ministerievan Gezondheidszorg. SEW. Tijdschrift voor Europees en EconomischRecht, 57(10), 404-406.Exter, A.P. den (2009). Concurrentievervalsende praktijken vanfarmaceutische multinationals. Economisch-Statistische Berichten,94, 509-509.Exter, A.P. den (2009). Farmacie rekt octrooien op. Medisch Contact,64(47), 1973-1973.Exter, A.P. den (2009). FarmaNostra. Nederlands Juristenblad (NJB),84, 2483-2485.Exter, A.P. den (2009). FarmaNostra. Antwerps FarmaceutischTijdschrift, 87(8), 20-21.Exter, A.P. den (2009). Internationale geneesmiddelen en het rechtop gezondheid. Mensenrechten & Gezondheidszorg, 12, 15-18.Geest, S.A. van der & Varkevisser, M. (2010). Keuzebeïnvloeding viaeigen risico werkt, maar kan beter. TPEdigitaal, 4(4), 34-48.Geest, S.A. van der & Varkevisser, M. (2010). Winstverbodziekenhuizen onder voorwaarden loslaten. Economisch-StatistischeBerichten, 95(4580), 152-154.Goris, A. & Varkevisser, M. (2009). Zorg zonder grenzen:veranderingen in vraag en aanbod in grensoverschrijdende zorg.Health Management Forum, 01(09), 6-10.Grit, K.J. & Bont, A.A. de (2009). Maakbare solidariteit. De impactvan overheidsbeleid op de solidariteit van de burgers. Krisis, 2, 22-32.Hermans, H.E.G.M., Muijsers, L. & Scholten, G.R.M. (2010). Wetgeverzet besturing zorginstellingen onder druk. Zorg en Financiering, 9(1),11-21.Hulst, E.H. (2009). Bedrijvenpoli en gelijke toegang tot reguliere zorg.Zorg en Financiering, 10-20.Hulst, E.H. (2010). Wat kan je doen als je van cliënten veel klachtenkrijgt over een bepaalde tandarts? Wat is de procedure als een patiënteen klacht wil indienen? Mondhygiëniste Vademecum, 8(3), 1-3.Kleef, R.C. van, Ven, W.P.M.M. van de & Vliet, R.C.J.A. van (2010).Een solidair eigen risico in de zorg. Economisch-Statistische Berichten,95(4592), 522-524.Noord, T.J.C. van (2010). De eerste Nederlandse farmacopee. TMATijdschrift voor Milieu en aansprakelijkheid, 24(3), 80-88.Noord, T.J.C. van (2010). De rook is nog niet opgetrokken: het rook -verbod in de horeca. TMA Tijdschrift voor Milieu en aansprakelijkheid,4, 154-170.66

Noord, T.J.C. van (2010). Gezondheidsrecht op zijn plaats in TMA.TMA Tijdschrift voor Milieu en aansprakelijkheid, 24(1), 5-11.Sande, R. van der, Hellendoorn, E., Roosenschoon, B.J., Noorthorn,E.O., Nijman, H.L.I., Staak, C. van der & Mulder, C.L. (2009). DeCrisismonitor. Het signaleren van agressie en het voorkomen vanseparatie. MGV, 64(6), 540-550.Schut, F.T. (2009). Is de marktwerking in de zorg doorgeschoten?S&D Polemiek, 7(8), 68-80.Schut, F.T. (2010). Marktwerking in de zorg: waar gaat het eigenlijkover? Nederlands Tijdschrift voor Geneeskunde, 154(B589).Schut, F.T., Ven, W.P.M.M. van de & Varkevisser, M. (2010).Prijsconcurrentie gaat niet samen met macrobudget ziekenhuizen.Economisch-Statistische Berichten, 95(4587), 374-376.Schut, F.T. & Ven, W.P.M.M. van de (2010). Structuur Duitsezorgpremies efficiënter dan Nederlandse. Economisch-StatistischeBerichten, 95(4596), 662-665.Schut, F.T. & Ven, W.P.M.M. van de (2010). Uitvoering AWBZ doorzorgverzekeraars onverstandig. Economisch-Statistische Berichten,95(4591), 486-489.Varkevisser, M., Geest, S.A. van der, Appelman, M. & Struijs, J. (2009).Regionale machtspositie zorggroepen baart zorgen. Economisch-Statistische Berichten, 94(4572), 701-701.Varkevisser, M. & Schut, F.T. (2010). Fusietoetsing in de zorg.Economisch-Statistische Berichten, 95(4576), 22-25.Ven, W.P.M.M. van de & Schut, F.T. (2010). Fout van CPB bij berekeningremgeldeffect eigen risico. TPEdigitaal, 4(2), 153-157.Ven, W.P.M.M. van de & Schut, F.T. (2010). Is de Zorgverzekeringsweteen succes? TPEdigitaal, 4(1), 1-24.ANNOTATIEANNOTATIONHulst, E.H. (2010). Noot bij: 's-Hertogenbosch (20-07-2010),TMA 2010-4, HD 200.041.998, (Specifiteitsvereiste door het Hofafgezwakt). p.196-198.Hulst, E.H. (2010). Noot bij: RB Leeuwarden (21-07-2010), TMA 2010-4,92832/HA ZA 08-912, (Conformiteitsvereiste, de plicht te reageren“binnen bekwame tijd” en de rol van een slechte reputatie).p.185-191.67

Onderzoeksthema 2: Kwaliteit endoelmatigheid in de gezondheidszorgResearch theme 2: Quality and safetyin health careORATIEINAUGURAL LECTUREBrouwer, W.B.F. (2009). De basis van het pakket.PROEFSCHRIFTPhD-THESISGalani, C.M. (2009). Health Technology Assessment of MedicalInterventions in the Prevention and Treatment of Disease Directions ofFurther Research and Policy Implications. Promotor: prof.dr. F.F.H.Rutten. Copromotor: dr. M.J. Al.Poel, E. van de (2009). Urbanization, Health and Inequality in theDeveloping World. Promotor: prof.dr. E.K.A. van Doorslaer.Copromotor: dr. O.A. O'Donnell.Tan, S.S. (2009). Microcosting in Economic Evaluations. Promotor:prof.dr. C.A. Uyl-de Groot. Copromotor: dr. L. Hakkaart-van Roijen.WETENSCHAPPELIJK ARTIKEL / BRIEF AAN DE REDACTIESCIENTIFIC ARTICLE / LETTER TO THE EDITORAbdellaoui, M., Attema, A.E. & Bleichrodt, H. (2010). Intertemporaltradeoffs for gains and losses: an experimental measurement ofdiscounted utility. The Economic Journal, 120(545), 845-866.Abellan-Perpiñan, J.M., Bleichrodt, H. & Pinto-Prades, J.L. (2009). Thepredictive validity of prospect theory versus expected utility in healthutility measurement. Journal of Health Economics, 28, 1039-1047.Aghdashi, M.M., Abbasivash, R., Hassani, E. & Pirnejad, H. (2009). Fatalrespiratory thermal injury following accidental adminstration ofcarbon dioxide using the circle system for a cesarean delivery.International Journal of Obstetric Anesthesia, 18(4), 400-402.Agyemang, C.O., Vrijkotte, T.G.M., Droomers, M., Wal, M.F., Bonsel,G.J. & Stronks, K. (2009). The effect of neighbourhood income anddeprivation on pregnancy outcomes in Amsterdam, The Netherlands.Journal of Epidemiology & Community Health, 63, 755-760.68

Al, M.J., Hakkaart-van Roijen, L., Tan, S.S. & Bakker, J. (2010). Costconsequenceanalysis of remifentanil-based analgo-sedation vs.conventional analgesia and sedation for patients on mechanicalventilation in the Netherlands. Journal of Critical Care, 14(195), 1-10.Al-Janabi, H., Frew, E., Brouwer, W.B.F., Rappange, D.R. & Exel, N.J.A.van (2010). The inclusion of positive aspects of caring in the CaregiverStrain Index: Tests of feasibility and validity. International Journal ofNursing Studies, 47, 984-993.Attema, A.E. & Brouwer, W.B.F. (2009). The correction of TTO-scores forutility curvature using a risk-free utility elicitation method. Journal ofHealth Economics, 28, 234-243.Attema, A.E., Lugnér, A.K. & Feenstra, T.L. (2010). Investment inantiviral drugs: a real options approach. Health Economics, 19, 1240-1254.Attema, A.E. & Brouwer, W.B.F. (2010). On the (not so) constantproportional trade-off in TTO. Quality of Life Research, 19, 489-497.Attema, A.E. & Brouwer, W.B.F. (2010). The Value of Correcting Values:Influence and Importance of Correcting TTO Scores for TimePreference. Value in Health, 13(8), 879-884.Attema, A.E., Bleichrodt, H., Rohde, K.I.M. & Wakker, P.P. (2010). Time-Tradeoff Sequences for Analyzing Discounting and Time Inconsistency.Management Science, 56(11), 2015-2030.Baal, P.H.M. van, Hoogenveen, R.T., Boshuizen, H.C. & Engelfriet, P.M.(2010). Indirect Estimation of Chronic Disease Excess Mortality.Epidemiology, 21(3), 1-2.Baal, P.H.M. van & Feenstra, T.L. (2010). Long-term effects of alcoholpolicies: an economic perspective. Addiction, 105, 395-396.Baeten, S.A., Baltussen, R.M.P.M., Uyl-de Groot, C.A., Bridges, J. &Niessen, L.W. (2010). Incorporating Equity-Effeciency Interactions inCost-Effectiveness Analysis-Three Approaches Applied to Breast CancerControl. Value in Health, 13(5), 573-579.Baeten, S.A., Exel, N.J.A. van, Dirks, M., Koopmanschap, M.A., Dippel,D.W.J. & Niessen, L.W. (2010). Lifetime health effects and medical costsof integrated stroke services - a non-randomized controlled clustertrialbased life table approach. Cost Effectiveness and ResourceAllocation, 8(21), 1-10.Baker, R., Exel, N.J.A. van, Mason, H. & Stricklin, M. (2010). ConnectingQ & Surveys: Three Methods to Explore Factor Membership in LargeSamples. Operant Subjectivity: The International Journal of QMethodology, 34(1), 38-58.69

Beeh, K.M., Hederer, B., Glaab, T., Muller, A., Rutten-van Mölken,M.P.M.H., Kesten, S. & Vogelmeier, C. (2009). Study designconsiderations in a large COPD trial comparing effects of tiotropiumwith salmeterol on exacerbations. International Journal of COPD, 4,119-125.Berghout, C.C., Zevalkink, J. & Hakkaart-van Roijen, L. (2010). A costutilityanalysis of psychoanalysis versus psychoanalytic psychotherapy.International Journal of Technology Assessment in Health Care, 26(1),3-10.Bijlenga, D., Birnie, E. & Bonsel, G.J. (2009). Feasibility, reliability, andvalidity of three health-state valuation methods using multipleoutcomevignettes on moderate-risk pregnancy at term. Value inHealth, 12(5), 821-827.Bleichrodt, H. & Pinto, J.L. (2009). New Evidence of PreferenceReversals in Health Utility Measurement. Health Economics, 18(6), 713-726.Bleichrodt, H. & Filko, M. (2010). A Reply to Gandjour and Gafni.Journal of Health Economics, 29, 329-331.Bobinac, A., Exel, N.J.A. van, Rutten, F.F.H. & Brouwer, W.B.F. (2010).Caring for and caring about: Disentangling the caregiver effect andthe family effect. Journal of Health Economics, 29, 549-556.Bobinac, A., Exel, N.J.A. van, Rutten, F.F.H. & Brouwer, W.B.F. (2010).Willingness to Pay for a Quality-Adjusted Life-Year: The IndividualPerspective. Value in Health, 13(8), 1049-1055.Boormans, E.M.A., Birnie, E., Bilardo, C.M., Oepkes, D., Bonsel, G.J. &Lith, J.M.M. van (2009). Karyotyping or rapid aneuploidy detection inprenatal diagnosis? The different views of users and providers ofprenatal care. Bjog-An International Journal of Obstetrics andGynaecology, 116(10), 1396-1399.Boormans, E.M., Birnie, E., Oepkes, D., Galjaard, R.J.H., Schuring-Blom,G.H. & Lith, J.M. van (2010). Comparison of Multiplex Ligation-Dependent Probe Amplification and Karyotyping in PrenatalDiagnosis. Bjog-An International Journal of Obstetrics andGynaecology, 115(2), 297-303.Boormans, E.M.A., Birnie, E., Knegt, A.C., Schuring-Blom, G.H., Bonsel,G.J. & Lith, J.M.M. van (2010). Aiming at multidisciplinary consensus:what should be detected in prenatal diagnosis? Prenatal Diagnosis, 30,1049-1056.Boormans, E.M.A., Birnie, E., Oepkes, D., Boekkooi, P.F., Bonsel, G.J. &Lith, J.M.M. van (2010). Individualized choice in prenatal diagnosis: theimpact of karyotyping and standalone rapid aneuploidy detection onquality of life. Prenatal Diagnosis, 30, 928-936.70

Boormans, E.M.A., Birnie, E., Oepkes, D., Bilardo, C.M., Wildschut,H.I.J., Creemers, J., Bonsel, G.J. & Lith, J.M.M. van (2010). The impact ofrapid aneuploidy detection (RAD) in addition to karyotyping versuskaryotyping on maternal quality of life. Prenatal Diagnosis, 30, 425-433.Boot, C.R.L., Exel, N.J.A. van & Gulden, J.W.J. van der (2009). "My LungDisease Won't Go Away, it's There to Stay": Profiles of Adaptation toFunctional Limitations in Workers with Asthma and COPD. Journal ofOccupational Rehabilitation, 3(13), 284-292.Bouwmans, C.A.M., Janssen, J., Huijgens, P. & Uyl de Groot, C.A.(2009). Costs of haematological adverse events in chronic myeloidleukaemia patients: a retrospective cost analysis of the treatment ofanaemia, neutropenia and thrombocytopenia in patients with chronicmyeloid leukaemia. Journal of Medical Economics, 12(2), 164-169.Brouwer, W.B.F., Grootenboer, S. & Sendi, P. (2009). The Incorporationof Income and Leisure in Health State Valuations When the Measure IsSilent: An Empirical Inquiry into the Sound of Silence. Medical DecisionMaking, 29, 503-512.Brouwer, W.B.F. & Rutten, F.F.H. (2010). The efficiency frontierapproach to economic evaluation: will it help German policy making?Health Economics, 19, 1128-1131.Buijsen, M.A.J.M. (2010). Autonomy, Human Dignity, and the Right tohealthcare: A Dutch Perspective. Cambridge Quarterly of HealthcareEthics, 19(3), 321-329.Christiaans, I., Langen, I.M. van, Birnie, E., Bonsel, G.J., Wilde, A.A.M.& Smets, E.M.A. (2009). Genetic Counseling and Cardiac Care inPredictively Tested Hypertrophic Cardiomyopathy Mutation Carriers:The Patiens' Perspective. American Journal of Medical Genetics Part A,149A, 1444-1451.Christiaans, I., Langen, I.M. van, Birnie, E., Bonsel, G.J., Wilde, A.A.M.& Smets, E.M.A. (2009). Quality of Life and Psychological Distress inHypertrophic Cardiomyopathy Mutation Carriers: A Cross-SectionalCohort Study. American Journal of Medical Genetics Part A, 149A,602-612.Christiaans, I., Kok, T.M., Langen, I.M. van, Birnie, E., Bonsel, G.J.,Wilde, A.A.M. & Smets, E.M.A. (2010). Obtaining insurance after DNAdiagnostics: a survey among hypertrophic cardiomyopathy mutationcarriers. European Journal of Human Genetics, 18, 251-253.Christiaans, I., Engelen, K. van, Langen, I.M. van, Birnie, E., Bonsel,G.J., Elliott, P. & Wilde, A.A.M. (2010). Risk stratification for suddencardiac death in hypertrophic cardiomyopathy: systematic review ofclinical risk markers. Europace, 12, 313-321.71

Christiaans, I., Birnie, E., Langen, I.M. van, Spaendonck-Zwarts, K.Y.,Tintelen, J.P. van, Berg, M.P. van den, Atsma, D.E., Helderman-van denEnden, A.T.J.M., Pinto, Y.M., Hermans-van Ast, J.F., Bonsel, G.J. &Wilde, A.A.M. (2010). The yield of risk stratification for sudden cardiacdeath in hypertrophic cardiomyopathy myosinbinding protein C genemutation carriers: focus on predictive screening. European HeartJournal, 31, 842-848.Cleveringa, F.G.W., Welsing, P.M.J., Donk, M. van den, Gorter, K.J.,Niessen, L.W., Rutten, G.E.H.M. & Redekop, W.K. (2010). Cost-Effectiveness of the Diabetes Care Protocol; a MultifacetedComputerized Decision Support Diabetes Management InterventionThat Reduces Cardiovascular Risk. Diabetes Care, 33(2), 258-263.Cobden, D.S., Niessen, L.W., Rutten, F.F.H. & Redekop, W.K. (2010).Modeling the economic impact of medication adherence in type 2diabetes: a theoretical approach. Journal of Patient Preference andAdherence, 4, 283-290.Cobden, D.S., Niessen, L.W., Barr, C.E., Rutten, F.F.H. & Redekop, W.K.(2010). Relationships among Self-Management, Patient Perceptions ofCare, and Health Economic Outcomes for Decision-Making and ClinicalPractice in Type 2 Diabetes. Value in Health, 13(1), 138-147.Craig, B.M. & Oppe, M. (2010). From a different angle: A novelapproach to health valuation. Social Science & Medicine, 70, 169-174.Denktas, S., Koopmans, G.T., Birnie, E., Foets, M.M.E. & Bonsel, G.J.(2009). Ethnic background and differences in health care use: anational cross-sectional study of native Dutch and immigrant elderly inthe Netherlands. International Journal of Equity in Health, 8(35), 1-9.Denktas, S., Koopmans, G.T., Birnie, E., Foets, M.M.E. & Bonsel, G.J.(2010). Underutilization of prescribed drugs use among firstgeneration elderly immigrants in the Netherlands. Bmc Health ServicesResearch, 10(176), 1-11.Dijk, M. van, Poley, M.J., Gischler, S.J., Mazer, P., Meijers-IJsselstijn, H.,Tibboel, D. & Latour, J.M. (2010). Parental satisfaction with follow-upservices for children with major anatomical congenital anomalies.Child Care Health & Development, 36(1), 101-109.Doctor, N.J., Miyamoto, J. & Bleichrodt, H. (2009). When are persontradeoffs valid? Journal of Health Economics, 28, 1018-1027.Doctor, J.N., Bleichrodt, H. & Lin, H.J. (2010). Health Utility Bias: Asystematic review and meta-analytic evaluation. Medical DecisionMaking, 30, 58-67.Dror, D.M. (2009). A socio-economic profile of the micro (health)insurance target population. Asia Insurance Review, 12, 80-81.72

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Gani, R., Griffin, J., Kelly, S. & Rutten-van Mölken, M.P.M.H. (2010).Economic analyses comparing tiotropium with ipratropium orsalmeterol in UK patients with COPD. Primary Care RespiratoryJournal, 19(1), 68-74.Gerhards, S.A.H., Graaf, L.E. de, Jacobs, L.E. de, Severens, J.L., Huibers,M.J.H., Arntz, A., Riper, H., Widdershoven, G., Metsemakers, J.F.M. &Evers, S.M.A.A. (2010). Economic evaluation of online computerisedcognitive-behavioural therapy without support for depression in primarycare: randomised trial. British Journal of Psychiatry, 196, 310-318.Goedhart, G., Wal, M., van der, Cuijpers, P. & Bonsel, G.J. (2009).Psychosocial problems and continued smoking during pregnancy.Addictive Behaviours, 34, 403-406.Goor, K.M., Sprundel, E. van, Lemij, H.G., Plochg, T., Klazinga, N.S. &Koopmanschap, M.A. (2010). Cost-effectiveness of monitoring glau comapatients in shared care: an economic evaluation alongside a randomizedcontrolled trial. Bmc Health Services Research, 10(312), 1-11.Goossens, L.M.A., Riemersma, R.A., Postma, D.S., Molen, T. van der &Rutten-van Mölken, M.P.M.H. (2009). An Economic Evaluation ofBudesonide/Formoterol for Maintenance and Retriever Treatment inAsthma in General Practice. Advances in Therapy, 26(9), 872-885.Goossens, L.M.A., Standaert, B., Hartwig, N.G., Hovels, A.M. & AL, M.J.(2009). Conclusions on cost-effectiveness of rotavirus vaccinationhighly dependent on assumptions. Vaccine, 27, 2531-2532.Graaf, G. de & Exel, N.J.A. van (2009). Using Q Methodology inAdministrative Ethics. Public Integrity, 11(1), 63-78.Grit, K.J. & Bont, A.A. de (2010). Tailor-made finance versus tailormadecare. Can the state strengthen consumer choice in healthcareby reforming the financial structure of long-term care? Journal ofMedical Ethics, 36, 79-83.Groenendijk, A.G., Birnie, E., Boeckxstaens, G.E., Roovers, J.P.W. &Bonsel, G.J. (2009). Anorectal Function Testing and AnalEndosonography in the Diagnostic Work-Up of Patients withPrimary Pelvic Organ Prolapse. Gynecologic & Obstetric Investigation,67, 187-194.Groenendijk, A.G., Birnie, E., Blok, S. de, Adriaanse, A.H., Ankum,W.M., Roovers, J.P.W. & Bonsel, G.J. (2009). Clinical-decision taking inprimary pelvic organ prolapse; the effects of diagnostic tests ontreatment selection in comparison with a consesus meeting.International Urogynecology Journal and Pelvic Floor Dysfunction, 20,711-719.Groot, C.A. de, Stupp, R. & Bent, M. van den (2009). Cost-effectivenessof temozolomide for the threatment of newly diagnosed glioblastomamultiforme. Expert review of pharmacoeconomics & outcomesresearch, 9(3), 235-241.74

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Hulst, E.H. (2009). Grondrechten en civiele aansprakelijkheid, vanZutphen tot Europa. TMA Tijdschrift voor Mileu en aansprakelijkheid,1(2), 4-14.Hulst, E.H. (2009). Zwaarwegend maatschappelijk belang als nieuwetoverformule. TMA Tijdschrift voor Mileu en aansprakelijkheid, 1(2),24-28.Hulst, E.H. (2010). De Codarcea-zaak: aanzet tot betere beschermingvan de gelaedeerde. TMA Tijdschrift voor Mileu en aansprakelijkheid,24(3), 75-79.Hulst, E.H. (2010). Redelijkheid in zaken van medischeaansprakelijkheid. De Halcion-zaak nader beschouwd aan de hand vaneen rechterljk vonnis uit 2010. TMA Tijdschrift voor Mileu enaansprakelijkheid, 1(2), 12-18.Jansen, Y.J.F.M. (2009). Etnografisch onderzoek onder collega's;voortdurende spanning tussen betrokkenheid en distantie. KWALON.Tijdschrift voor Kwalitatief Onderzoek in Nederland, 14(3), 27-31.Kippersluis, J.L.W. van, Doorslaer, E.K.A. van & Ourti, T.G.M. van(2009). Inkomen alleen maakt niet gezond. Economisch-StatistischeBerichten, 94(4551), 20-23.Lötters, F.J.B., Slockers, M.T. & Tilburg, Y. van (2010). De ondersteonderkant van de samenleving. Medisch Contact, 65(50), 2706-2707.Rutten, F.F.H. (2009). Zicht op zorgpakketten in Europa; resultaten vanhet Health Basket Project. Health Management Forum, 1, 28-30.Rutten, F.F.H. & Brouwer, W.B.F. (2010). Behoedzaam bezuinigen in dezorg. Economisch-Statistische Berichten, 95(4586), 343-344.Schulte, P.F.J., Bogers, J.P.A.M. & Steenhoek, A. (2010). Antwoord aanLieverse en Bet. Ingezonden stuk. Tijdschrift voor Psychiatrie, 52(5),358-359.Schulte, P.F.J., Bogers, J.P.A.M. & Steenhoek, A. (2010). Nieuwe versusoude antipsychotica: weinig voordelen in echte wereld. Tijdschrift voorPsychiatrie, 52(3), 181-190.Steenhoek, A. & Koopmanschap, M.A. (2010). Doelmatigheid duremedicijnen afwegen. Medisch Contact, 65(35), 1709-1711.Steenhoek, A., Koopmanschap, M.A., Franken, M.G. & Rutten, F.F.H.(2010). Nieuwe geneesmiddelen: niet goed, geld terug? NederlandsTijdschrift voor Geneeskunde (NTvG), 154(A2042), 1-5.86

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Onderzoeksthema 3: Management enorganisatie van zorgverleningResearch theme 3: Management andorganisation of health careORATIEINAUGURAL LECTUREKlundert, J.J. (2009). Value-Conscious Health Service Organisations.Klein, J. (2010). Tussen de modder van de praktijk en de schonewetenschap.Putters, K. (2009). Besturen met duivelselastiek.Robben, P.B.M. (2010). Toezicht in een glazen huis. Effectiviteit van hettoezicht op de kwaliteit van de gezondheidszorg.PROEFSCHRIFTPhD-THESISCramm, J.M. (2010). Health and social burdens of people living in aneconomically and health-deprived area. Promotor: prof.dr. J.J. van deKlundert. Copromotor: dr. A.P. Nieboer.Lemmens, K.M.M. (2009). Improving Chronic Care Developing andtesting disease-management interventions applied in COPD care.Promotor: prof.dr. R. Huijsman. Copromotor: dr. A.P. Nieboer.Mul, M. de. (2009). Managing Quality in Health Care. Promotor:prof.dr. M. Berg. Copromotor:dr. A. de Bont.Niazkhani, Z. (2009). A Fit between Clinical Workflow and Health CareInformation Systems. Promotor: prof.dr. M. Berg. Copromotor: dr.J.E.C.M. Aarts.Stepaniak, P.S. (2010). Modeling and management of variation in theoperating theatre. Promotor: prof.dr.ir. G. de Vries. Copromotor:prof.dr. J. van de Klundert.88

WETENSCHAPPELIJK ARTIKEL / BRIEF AAN DE REDACTIESCIENTIFIC ARTICLE / LETTER TO THE EDITORAarts, J.E.C.M. & Koppel, R. (2009). Implementation Of ComputerizedPhysician Order Entry In Seven Countries. Health Affairs, 28(2), 404-414.Aarts, J.E.C.M. (2009). Computerized Order Entry: The AuthorsRespond. Health Affairs, 28(4), 1232-1232.Aarts, J.E.C.M. & Sijs, H. van der (2009). CPOE, alerts and workflow:taking stock of ten years research at Erasmus MC. Studies in HealthTechnology and Informatics, 148, 165-169.Aarts, J.E.C.M., Callen, J., Coiera, E. & Westbrook, J. (2010).Information Technology in Health Care: Socio-technical approaches.International Journal of Medical Informatics, 79, 389-390.Adams, S.A. (2010). Blog-based applications and health information:Two case studies that illustrate important questions for ConsumerHealth Informatics (CHI) research. International Journal of MedicalInformatics, 79, e89-e96.Adams, S.A. (2010). Revisiting the online health informationreliability debate in the wake of "web 2.0": An inter-disciplinaryliterature and website review. International Journal of MedicalInformatics, 79, 391-400.Adan, I., Bekkers, J., Dellaert, N.P., Vissers, J.M.H. & Yu, X. (2009).Patient mix optimisation and stochastic resource requirements: A casestudy in cardiothoracic surgery planning. Health Care ManagementScience, 12, 129-141.Ahaus, C.T.B., & Huijsman, R. (2009). A four phase development modelfor integrated care services in the Netherlands. BMC Health ServicesResearch, 9, 42-42.Berg, M. van den, Frenken, R. & Bal, R.A. (2009). Quantitative datamanagement in quality improvement collaboratives. BMC HealthServices Research, 9(175), 1-11.Beuscart Zephir, M.C., Aarts, J.E.C.M. & Elkin, P. (2010). Human factorsengineering for healthcare IT clinical applications. InternationalJournal of Medical Informatics, 79(4), 223-224.Broer, T., Nieboer, A.P. & Bal, R.A. (2010). Opening the black box ofquality improvement collaboratives: an Actor-Network theoryapproach. Bmc Health Services Research, 10(265), 1-9.Broer, T., Nieboer, A.P. & Bal, R.A. (2010). Quest for client autonomy inimproving long-term mental health care. Issues in Mental HealthNursing, 19(6), 385-393.89

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Minkman, M.M.N., Ahaus, K. & Huijsman, R. (2010). HetOntwikkelingsmodel voor Ketenzorg. Tijdschrift voor Management &Organisatie, (5), 26-43.Oostrum, J.M. van & Klundert, J.J. van de (2009). EPDs: Hefboomverbetering van zorgprocessen. ZM Magazine, 12, 4-6.Pons, H., Lingsma, H.F. & Bal, R.A. (2009). De ranglijst is een slechteraadgever. Medisch Contact, 64(47), 1969-1972.Schreiner, N.A.F.M. (2009). Mentoraat aantoonbaar zinvol voor HR.Gids voor Personeelsmanagement, 11, 22-25Schreiner, N.A.F.M. (2010). Loopbaan- en talentontwikkeling voor hetindividu. Rotterdam: Uitgave in eigen beheer.Sonnaville, H. de, Hamers, H. & Huijsman, R. (2009). Scenario'sstrategische GGz keuzes. ZM Magazine, 7(25), 16-20.Staa, A.L. van & Jedeloo, S. (2009). Q-methodologie, een werkelijkemix van kwalitatief en kwantitatief onderzoek. KWALON. Tijdschriftvoor Kwalitatief Onderzoek in Nederland, 14(2), 5-15.Staa, A.L. van (2009). Snakes & Ladders: Hoe meer participatie, hoebeter? KWALON. Tijdschrift voor Kwalitatief Onderzoek in Nederland,14(1), 15-21.Staa, A.L. van & Adams, S.A. (2010). Internet & kwalitatief onderzoek.KWALON. Tijdschrift voor Kwalitatief Onderzoek in Nederland, 15(2),3-11.Staa, A.L. van, Havers, J. & Sonneveld, H.M. (2010). Overstappen;Transitie van chronisch zieke jongeren. Tijdschrift voorKindergeneeskunde, 1, 4-5.Staa, A.L. van, Eysink Smeets-van de Burgt, A.E., Stege, H.A. van der &Hilberink, S.R. (2010). Transitie in zorg van jongeren met chronischeaandoeningen in Nederland nog onder de maat. Tijdschrift voorKindergeneeskunde, 78(6), 227-236.Steenkamer, B., Goede, J. de, Treurniet, H.F., Putters, K. & Oers, H. van(2010). Het gebruik van (volks)gezondheidsinformatie doorbeleidsmakers: een studie in Midden-Holland. TSG, 88(8), 461-469.Stege, H.A. van der & Staa, A.L. van (2010). Let's talk about sex -ontwikkeling van en eerste ervaringen met SeCZ TaLK, bordspel voorchronisch zieke jongeren. Tijdschrift voor Kindergeneeskunde, 78(1),91-92.Stoopendaal, A.M.V. (2009). Afstand tussen zorgbestuur en werkvloer.Nederlands Tijdschrift voor Ergotherapie, 2, 14-18.98

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Rapportenen working papersReports andworking papersBMG reeksBMG seriesRAPPORTENREPORTSBlommestein, S.G.R., Cornelissen, H.M.,Huijgens, P.C. & Uyl-de Groot, C.A., Verelst,J.J., (2010). Kostprijzen van autologe enallogene hematopoietische stamceltrans -plantaties voor hematologische ziekten.Boonen, L.H.H.M., Laske-Aldershof, T. &Schut, F.T. (2009). Het effect van CQ-infor -matie op de keuze voor een zorgverzekeraar.effectiveness and efficiency of a Glaucomafollow-up unit, staffed by nonphysicianhealth care professionals, as an intermediatestep towards glaucoma monitoring inprimary care.Al, M.J. & Feenstra, T., Hoogendoorn,Hoogenveen, R., E.J.I., Rutten-van Mölken,M.P.M.H., (2010). Comparing the costeffectivenessof a wide range of COPDinterventions using a stochastic, dynamic,population model for COPD.Bont, A.A. de, Jerak, S., Mul, M. de & Zwart,D. (2009). Vragen voor veiligheid. De bete -kenis van patiëntveiligheid in de eerste lijn.Bal, R.A. & Meurs, P.L., Bont, A.A. de, Jerak,S.A., Zuiderent, T., (2009). Veiligheid in dezorg. Achtergrondstudie bij de staat van degezondheidszorg.Neefjes, F.C.J. & Bal, R.A., Niezen-van derZwet, M.G.H., (2010). Leren van toezicht.Over effectiviteit van thematisch toezichtdoor de inspectie voor de gezondheidszorg.Grit, K.J., Janssen, M., Putters, K., Schmidt,D. & Meurs, P.L. (2010). Governance of localcare & social service.100Holtzer-Goor, K.M., Klazinga, N.S.,Koopmanschap, M.A., Lemij, H.G., Plochg, T.& Sprungel, E. van (2010). Monitoring ofstable glaucoma patients. Evaluation of theGeest, S.A. van der & Schut, F.T., Varkevisser,M., (2009). Mededingingsvraagstukken bij demedisch specialistische vervolgopleidingen inNederland.

WORKING PAPERSWORKING PAPERSAttema, A.E. & Brouwer, W.B.F. (2009). Thevalue of correcting values. Influence andimportance of correcting TTO scores fordiscounting.Attema, A.E. & Brouwer, W.B.F. (2009). Insearch of a preferred preference elicitationmethod. A test of the internal consistency ofchoice and matching procedures.Attema, A.E. & Brouwer, W.B.F. (2009).Constantly proving the opposite. A test ofCPTO using a broad time horizon andcorrecting for discouting.Attema, A.E. & Brouwer, W.B.F. (2009). Theway that you do it? An elaborate test ofprocedural invariance of TTO, using a choicebaseddesign.Cameron, A., Ewen, M., Laing, Niëns, L.M.,Poel, E. van de, R. & Brouwer, W.B.F. (2009).Practical measurements of affordability: anapplication to medicines.Evers, L., Oostrum, J.M. van & Wagelmans,A.P.M. (2010). More levelled bed occupancyand controlled waiting lists using mastersurgical schedules.Grit, K.J. & Grinten, T.E.D. van der, Zuiderent-Jerak, T., (2010). Markets and public values inhealthcare.Leunis, A. & Varkevisser, M. (2009). Internalmedicine residents’ perceptions of the clinicallearning environment in Dutch teachinghospitals – use of the Postgraduate HealthEducational Environment Measure (PHEEM).Roos, A.F. & Schut, F.T. (2009). Spillover effectsof supplementary on basic health insurance:evidence from the Netherlands.Varkevisser, M. & Schut, F.T. (2009). Hospitalmerger control. An international comparison.101

This activities report providesan overview of the mostimportant developments ofInstitute of Health Policy &Management (iBMG) in theyears 2009 and 2010.The Institute again occupieda prominent position in thehealth care sector in thesedynamic and fascinating years.In the fields of education andresearch iBMG achieved severalnoteworthy successes.Please enjoy the read.