http://repub.eur.nl/res/aut/2609/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/37342/ 2012-03-01T00:00:00Z A necessary condition for competition to promote quality in hospital markets is that patients are sensitive to differences in hospital quality. In this paper we examine the relationship between hospital quality, as measured by publicly available quality ratings, and patient hospital choice for angioplasty using individual claims data from a large health insurer. We find that Dutch patients have a high propensity to choose hospitals with a good reputation, both overall and for cardiology, and a low readmission rate after treatment for heart failure. Relative to a mean readmission rate of 8.5% we find that a 1%-point lower readmission rate is associated with a 12% increase in hospital demand. Since readmission rates are not adjusted for case-mix they may not provide a correct signal of hospital quality. Insofar patients base their hospital choice on such imperfect quality information, this may result in suboptimal choices and risk selection by hospitals. http://repub.eur.nl/res/pub/37341/ 2012-01-01T00:00:00Z Voor zorgconsumenten komt steeds meer vergelijkende kwaliteitsinformatie beschikbaar om weloverwogen een zorgaanbieder te kiezen. Uit een enquête blijkt dat deze informatie nog maar weinig wordt gebruikt. Veel patiënten vragen advies aan hun huisarts. Meer inzicht in het beperkte gebruik van vergelijkende kwaliteitsinformatie en de adviesrol van huisartsen is wenselijk. http://repub.eur.nl/res/pub/19435/ 2009-11-01T00:00:00Z http://repub.eur.nl/res/pub/20169/ 2009-08-01T00:00:00Z http://repub.eur.nl/res/pub/17100/ 2009-01-01T00:00:00Z Health care reforms in several European countries provide health insurers with incentives and tools to become prudent purchasers of health care. The potential success of this strategy crucially depends on insurers' bargaining leverage vis-à-vis health care providers. An important determinant of insurers' bargaining power is the willingness of consumers to consider alternative providers. In this paper we examine to what extent consumers are willing to switch hospitals when they are fully covered for hospital services, which is typical for many European countries. Since prices do not matter to these patients, we estimate time-elasticities to assess hospital substitutability. Using data from a large Dutch health insurer on non-emergency neurosurgical outpatient hospital visits in 2003, we estimate a conditional logit model of patient hospital choice taking both patient heterogeneity and hospital characteristics into account. We use the parameter estimates to simulate the demand effect of an artificial increase in travel time by 10% for every patient, holding all other hospital attributes constant. Overall, the resulting point estimates of hospitals' time-elasticities are fairly high, although variation is substantial (-2.6 to -1.4). Sensitivity tests reveal that these estimates are very robust and differ significantly across individual hospitals. This implies that all hospitals in our study sample have at least one close substitute which is an important precondition for effective hospital competition. http://repub.eur.nl/res/pub/19421/ 2008-12-12T00:00:00Z Sinds 1997 zijn de prestaties van IVF-centra op internet onderling vergelijkbaar. Zorggebruikers lijken de beschikbare kwaliteitsinformatie te gebruiken. IVF-centra in de Randstad met een hoger percentage doorgaande zwangerschappen hebben een groter marktaandeel. http://repub.eur.nl/res/pub/14053/ 2008-11-10T00:00:00Z The literature suggests that competition among schools might increase quality. However, not much empirical evidence is present as only a few countries allow competition at a large scale. One exception is the Netherlands. Free parental choice is the leading principle of the Dutch education system since the beginning of the 20th century. Based on panel data for the Netherlands we show that there is a relation between competition and student achievement in upper secondary education, but that it is negative. In addition, private schools have higher quality levels. http://repub.eur.nl/res/pub/23568/ 2008-01-01T00:00:00Z Keuzevrijheid bestaat al jaren in het voortgezet onderwijs en maakt dat scholen onderling concurreren. Door de beschikbaarheid van meer informatie kunnen ouders en leerlingen steeds beter kiezen. Concurrentie tussen scholen leidt echter niet tot meer onderwijsrendement in termen van cijfers of slagingspercentages. http://repub.eur.nl/res/pub/11266/ 2006-01-01T00:00:00Z In hun ESB-artikel van 24 maart 2006 betogen Van Damme en Mulder (VD&M) dat de waterlasten omlaag kunnen. Hoewel we het eens zijn met de diagnose dat verbetering van de doelmatigheid mogelijk is en dat consumenten daar meer van moeten profiteren, verschillen we van mening over de gewenste oplossing om dit te bereiken. http://repub.eur.nl/res/pub/6585/ 2005-04-01T00:00:00Z This paper analyzes adjustments in the Dutch retail gasoline prices. We estimate an error correction model on changes in the daily retail price for gasoline (taxes excluded) for the period 1996-2004 taking care of volatility clustering by estimating an EGARCH model. It turns out the volatility process is asymmetrical: an unexpected increase in the producer price has a larger effect on the variance of the producer price than an unexpected decrease. We do not find strong evidence for amount asymmetry. However, there is a faster reaction to upward changes in spot prices than to downward changes in spot prices. This implies timing or pattern asymmetry. This asymmetry starts three days after the change in the spot price and lasts for four days. http://repub.eur.nl/res/pub/11267/ 2005-01-01T00:00:00Z Benchmarking heeft de efficiëntie van de drinkwatersector in de afgelopen jaren aanzienlijk verbeterd. Het introduceren van ingrijpendere vormen van marktwerking ligt niet voor de hand. http://repub.eur.nl/res/pub/11268/ 2004-01-01T00:00:00Z Het kabinetsplan om de vergoedingslimieten van geneesmiddelen drastisch te verlagen, kan ernstige bijwerkingen hebben. http://repub.eur.nl/res/pub/10899/ 2003-11-01T00:00:00Z Abstract This article analyses the retail price adjustments in the Dutch gasoline market. We estimate an asymmetric error correction model on weekly price changes for the years 1996–2001. We construct five datasets, one for each working day. The conclusions on asymmetric pricing are shown to differ over these datasets, suggesting that the choice of the day for which the prices are observed matters more than commonly believed. In our view, the insufficient robustness of the outcomes might explain the mixed conclusions found in the literature. Using these two approaches, we also show that the effect of asymmetry on the Dutch consumer costs is negligible. http://repub.eur.nl/res/pub/894/ 2003-09-16T00:00:00Z Dit rapport doet verslag van een in opdracht van het Ministerie van Sociale Zaken en Werkgelegenheid door OCFEB verrichte studie. Het onderzoek is mede geïnspireerd door het zogenoemde ?proces van Lissabon?, dat erin moet resulteren dat de Europese Unie (EU) binnen tien jaar de meest concurrerende en dynamische kenniseconomie van de wereld is. Op basis van empirische feiten ontleend aan recente economische literatuur wordt in kaart gebracht hoe het proces van economische integratie in de EU zich heeft gemanifesteerd, welke verschillen er (nog) bestaan tussen de lidstaten en wat mogelijke belemmeringen van de economische dynamiek in Europa zijn. http://repub.eur.nl/res/pub/810/ 2003-09-02T00:00:00Z This paper analyses retail price adjustments in the Dutch gasoline market. We estimate an asymmetric error correction model on weekly price changes for the years 1996 to 2001. We construct five datasets, one for each working day. The conclusions on asymmetric pricing are shown to differ over these datasets, suggesting that the choice of the day for which prices are observed matters more than commonly believed. In our view, the insufficient robustness of outcomes might explain the mixed conclusions found in the literature. Using two approaches, we also show that the effect of asymmetry on Dutch consumer costs is negligible. http://repub.eur.nl/res/pub/814/ 2003-09-02T00:00:00Z In general, competition enhances efficiency. On the market for health insurance free market competition, however, has unwanted side-effects. The existence of asymmetrical information can lead to adverse selection and cream skimming. Adequate risk-adjustment removes the incentives for cream skimming and balances the negative consequences of adverse selection. In an attempt to enhance efficiency, the Dutch government in 1992 introduced price competition between social health insurers in combination with risk-adjusted capitation payments. Our estimation results indicate that this has not resulted in altering market shares. Relatively cheap insurers did not enlarge their market share at the expense of their relatively expensive competitors. The introduction of competition among social health insurers has not been the success the Dutch government hoped for. Experiences in Belgium and Germany show that the Dutch difficulties are not exceptional. When equity considerations are high valued features of a health insurance system, it is difficult to introduce competition. To enhance efficiency, we recommend that the current capitation formula should be refined and that the insurers should be given more room for selective contracting of health care providers.