http://repub.eur.nl/res/aut/14298/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/18500/ 2006-09-25T00:00:00Z Abstract Purpose – To address lessons that specify the impact and contribution of current scenario methods when focused on facilitating transition management processes. Design/methodology/approach – Comparative literature review based on transition management and scenario development. Research limitations/implications – Need of further systemic thought about the required criteria of transition scenarios and the embedding of scenario use in transition management processes. Practical implications – Processes of transition management are in need of transition specific scenarios. Originality/value – Because transition management implies a complex and long-term steering paradigm with which current scenario applications are not familiar, conclusions are drawn on the (changing) requirements of scenario development processes in transition management and on the need to innovate current scenario methods in the context of transition management. http://repub.eur.nl/res/pub/8376/ 2002-01-01T00:00:00Z STUDY OBJECTIVE: To determine changes in socioeconomic inequalities in self reported health in both the 1980s and the 1990s in the Netherlands. DESIGN: Analysis of trends in socioeconomic health inequalities during the last decades of the 20th century were made using data from the Health Interview Survey (Nethhis) and the subsequent Permanent Survey on Living Conditions (POLS) from Statistics Netherlands. Socioeconomic inequalities in self assessed health, short-term disabilities during the past 14 days, long term health problems and chronic diseases were studied in relation to both educational level and household income. Trends from 1981 to 1999 were studied using summary indices for both the relative and absolute size of socioeconomic inequalities in health. SETTING: The Netherlands. PARTICIPANTS: For the period 1981-1999 per year a random sample of about 7000 respondents of 18 years and older from the non-institutionalised population. MAIN RESULTS: Socioeconomic inequalities in self assessed health showed a fairly consistent increase over time. Socioeconomic inequalities in the other health indicators were more or less stable over time. In no case did socioeconomic inequalities in health seemed to have decreased over time. Socioeconomic inequalities in self assessed health increased both in the 1980s and the 1990s. This increase was more pronounced for income (as compared with education) and for women (as compared with men). CONCLUSION: There are several possible explanations for the fact that, in addition to stable health inequalities in general, income related inequalities in some health indicators increased in the Netherlands, especially in the early 1990s. Most influential were perhaps selection effects, related to changing labour market policies in the Netherlands. The fact that the health inequalities did not decrease over recent years underscores the necessity of policies that explicitly aim to tackle these inequalities. http://repub.eur.nl/res/pub/11381/ 2001-01-01T00:00:00Z The Belgian Health Interview Survey held in 1997 is very comparable to the Netherlands Health Interview Survey 1997. We use data from both surveys to compare levels and distributions of health care utilization in both countries. In addition to testing for differences in level and distribu­tion of medical care utilization, this study also examines whether any of these differences are attributable to differences in health care system char­acteristics. Need-standardised concentration indices are used to measure the degree of income-related inequality and inequity. The findings are that, in general, Belgians are more intensive users of the health care system, with a higher use of the GP, the specialist, the hospital and prescribed medicines. The Dutch, on the other hand, report more frequent contacts with the dentist. No significant inequity is found for the utilization of GP or hospital inpatient care. Significant inequity is observed in both countries with respect to the number of specialist contacts only: higher income indi­viduals make more use of specialist services than expected on the basis of predicted need. The degree of such inequitable specialist use is remark­ably similar given the substantial differences in referral systems, copay­ments and doctor availability between both countries. Neither the abun­dant supply and direct accessibility of medical specialists in Belgium, nor the private insurance status of higher income individuals in the Netherlands can account for this finding. http://repub.eur.nl/res/pub/11391/ 2000-09-01T00:00:00Z This paper presents a comparison of horizontal equity in health care utilization in 10 European countries and the US. It does not only extend previous work by using more recent data from a larger set of countries, but also uses new methods and presents disaggregated results by various types of care. In all countries, the lower-income groups are more intensive users of the health care system. But after indirect standardization for need differences, there is little or no evidence of significant inequity in the delivery of health care overall, though in half of the countries, significant pro-rich inequity emerges for physician contacts. This seems to be due mainly to a higher use of medical specialist services by higher-income groups and a higher use of GP care among lower-income groups. These findings appear to be fairly general and emerge in countries with very diverse characteristics regarding access and provider incentives. http://repub.eur.nl/res/pub/9345/ 2000-01-01T00:00:00Z OBJECTIVE: To investigate international variations in smoking associated with educational level. DESIGN: International comparison of national health, or similar, surveys. SUBJECTS: Men and women aged 20 to 44 years and 45 to 74 years. SETTING: 12 European countries, around 1990. MAIN OUTCOME MEASURES: Relative differences (odds ratios) and absolute differences in the prevalence of ever smoking and current smoking for men and women in each age group by educational level. RESULTS: In the 45 to 74 year age group, higher rates of current and ever smoking among lower educated subjects were found in some countries only. Among women this was found in Great Britain, Norway, and Sweden, whereas an opposite pattern, with higher educated women smoking more, was found in southern Europe. Among men a similar north-south pattern was found but it was less noticeable than among women. In the 20 to 44 year age group, educational differences in smoking were generally greater than in the older age group, and smoking rates were higher among lower educated people in most countries. Among younger women, a similar north-south pattern was found as among older women. Among younger men, large educational differences in smoking were found for northern European as well as for southern European countries, except for Portugal. CONCLUSIONS: These international variations in social gradients in smoking, which are likely to be related to differences between countries in their stage of the smoking epidemic, may have contributed to the socioeconomic differences in mortality from ischaemic heart disease being greater in northern European countries. The observed age patterns suggest that socioeconomic differences in diseases related to smoking will increase in the coming decades in many European countries. http://repub.eur.nl/res/pub/8824/ 1998-01-01T00:00:00Z BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries. http://repub.eur.nl/res/pub/8833/ 1998-01-01T00:00:00Z STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed. http://repub.eur.nl/res/pub/11470/ 1987-01-01T00:00:00Z Empirical studies of supplier-induced demand in health care have mostly concentrated on the analysis of physician behaviour. In this article, the focus is on the economic determinants of physiotherapist behaviour in The Netherlands. It is shown that relative prices work as strong incentives to alter the mix of services supplied, conform to the model of revenue maximization under a production constraint. However, the time-series analysis also gives some indication that this ability to influence the demand for their services to increase hourly income is not fully exploited. The latter finding is inconsistent with pure income maximization but rather points to a trade-off between loss of revenue and demand manipulation. The fact that the choice of therapy varies with the pressure on provider incomes does cast some doubt on the appropriateness of the chosen patterns of treatment in terms of effectiveness.