http://repub.eur.nl/res/aut/9577/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/37235/ 2010-09-16T00:00:00Z Background: In the Netherlands municipalities are legally required to draw up a Local Health Policy Memorandum every four years. This policy memorandum should be based on (local) epidemiological research as performed by the Regional Health Services. However, it is largely unknown if and in what way epidemiological research is used during local policy development. As part of a larger study on knowledge utilization at the local level in The Netherlands, an analytical framework on the use of epidemiological research in local health policy development in the Netherlands is presented here.Method: Based on a literature search and a short inventory on experiences from Regional Health Services, we made a description of existing research utilization models and concepts about research utilization. Subsequently we mapped different barriers in research transmission.Results: The interaction model is regarded as the main explanatory model. It acknowledges the interactive and incremental nature of policy development, which takes place in a context and includes diversity within the groups of researchers and policymakers. This fits well in the dynamic and complex setting of local Dutch health policy.For the conceptual framework we propose a network approach, in which we "extend" the interaction model. We not only focus on the one-to-one relation between an individual researcher and policymaker but include interactions between several actors participating in the research and policy process.In this model interaction between actors in the research and the policy network is expected to improve research utilization. Interaction can obstruct or promote four clusters of barriers between research and policy: expectations, transfer issues, acceptance, and interpretation. These elements of interactions and barriers provide an actual explanation of research utilization. Research utilization itself can be measured on the individual level of actors and on a policy process level.Conclusion: The developed framework has added value on existing models on research utilization because it emphasizes on the 'logic' of the context of the research and policy networks. The framework will contribute to a better understanding of the impact of epidemiological research in local health policy development, however further operationalisation of the concepts mentioned in the framework remains necessary. http://repub.eur.nl/res/pub/19781/ 2010-06-01T00:00:00Z Abstract: Discussions on the role of markets in healthcare easily lead to political and unfruitful polarized positions. Actors arguing in favour of markets as a solution for the quality/cost conundrum entrench themselves against others pointing out the risk of markets for the delivery and governance of healthcare. These binary options of more or less marketization preclude a more empirical analysis of how markets, as multiple arrangements, are constructed and what their consequences are for public values like affordability and quality. To empirically explore the relation between markets and public values in healthcare, in this paper we analyze the construction of a market for hospital care in the Netherlands, based on a system of diagnoserelated groups (DBCs), and the development of a market for long term care based on care-load packages (ZZPs). In these cases we address the intended result of care markets according to various policy actors, the visible and invisible work done by various actors to make markets work and the values enacted in market practices. We show that where policy aims within these markets focus on providing choice and increasing diversity of care institutions, the instruments of DBCs and ZZPs rather produce isomorphism and homogenization. Furthermore, the strong influence of financial instruments in shaping healthcare markets assume that cost and quality can both be strengthened while it in fact has a profound influence on how public values like quality get defined in practice. These translations between values pursued and outcomes produced indicate that conceptualizing the role of the state as defining public values that markets (have to) implement is problematic, as this removes crucial normative work in the shaping of our welfare states to the realm of the technical operationalization of markets. An alternative relation between state, market and society can be conceived once we accept that such values are shaped in practice and that the relationship between policy aims and policy consequences can never be fully captured through a logic of implementation. This then calls for an experimental role of the state: a state that sees market developments as experimental devices in which the aim is a good composition of public values. We propose this experimentation could for example focus on market developments that do not ascribe a privileged status to financial devices and price-mechanism, such as a market for the DBC A-segment, in which prices are not freely negotiable. Such experiments could allow competition to focus on other public values like quality and maintaining accessibility while at the same time function as learning laboratories for reconceiving the role between state, market and society. http://repub.eur.nl/res/pub/37268/ 2010-01-01T00:00:00Z The Redes de Trueque (RT) thrived during the economic crisis of 2001 – 2002 in Argentina and still stand out as one of the largest Complementary Currency System in the world. These local exchange networks reach a large scale during times of severe economic distress, but as large non-state initiatives, they pose a governance problem. Four types of governance systems were structured within the Argentine RT, of varying degrees of sustainability: a) loosely regulated market systems, b) hierarchies, c) associational regional networks, and d) local communities. Based on a four dimensional analytical framework, this paper discusses the rules of governance and sustainability of the governance systems in the RT. It found that some became more sustainable than others in terms of achieving combinations of scale and organisational modes. http://repub.eur.nl/res/pub/8397/ 2006-11-17T00:00:00Z Het is niet ongebruikelijk om bij een gelegenheid als deze terug te kijken naar de ontwikkelingen op het gebied van de leerstoel gedurende de periode dat men daar zelf bij betrokken was. Voor mij zou dit betekenen dat ik terugblik en refl ecteer op 35 jaar beleid en organisatie van de gezondheidszorg. Dit is wel heel erg ruim. Ik spits dit afscheidscollege daarom toe op een thema dat mij gedurende deze hele periode in het bijzonder heeft gefascineerd en mij zowel maatschappelijk als wetenschappelijk heeft beziggehouden. Dat is het thema van de sturing van de gezondheidszorg en de instituties die hiervoor zijn opgetrokken. Hoe zijn de bestuurlijke taken, verantwoordelijkheden en bevoegdheden in de gezondheidszorg verdeeld en hoe verhoudt deze verdeling zich tot de behoeften van de sector? Is dit bestuurlijke bestel wel in staat om de vernieuwingen in de zorg te accommoderen en als dit niet het geval is, wat gebeurt er dan? Reageert het bestuur op externe ontwikkelingen, beantwoordt het vooral aan een eigen bestuurlijke logica? http://repub.eur.nl/res/pub/10815/ 2005-07-01T00:00:00Z Practitioners and academic researchers increasingly look to evaluation of health impact assessment (HIA) to improve its practice, its efficiency and its legitimacy. Evaluation is also used to account to policy-makers, who express doubts that the benefits of HIA justify its costs. Until recently evaluation of HIA focused on instrument design and procedures but now the focus needs to shift to analysis of the interaction of HIA and decision-making. Multiple case studies have been applied to identify the conditions in which HIA produces the desired benefits. These studies used analytical concepts derived from the literature on evaluation, knowledge utilization, science of sociology and knowledge management. This paper describes a case study in which the strategic motives of the decision-makers affected the impact of an HIA. This HIA comprised of a quantitative environmental model dCity & EnvironmentT that was used to assess environmental health impacts of an urban reconstruction plan in a Dutch city. The evaluation of the HIA shows that the decision to follow the recommendations of the HIAwas part of a damage control strategy. The more HIA goals deviate from the policy problem and the less HIA is embedded in institutional procedures, then the more HIA impact will be subject to strategic decisionmaking behaviour. Appropriate cognitive and social strategies are needed to avoid 'negative learning' in those the HIA seeks to influence http://repub.eur.nl/res/pub/1758/ 2004-10-19T00:00:00Z Session 4: Public Management http://repub.eur.nl/res/pub/10814/ 2004-02-01T00:00:00Z Like any policy-relevant research, HIA faces the risk of not being used by decisionsmakers. This article addresses the questions: ‘‘How do policy decisions come about?’’ and ‘‘How does this affect HIA?’’ Current literature in political-administrative sciences identifies three ways for decision-making: rational, incremental and mixed model. These models define the relationship between the policy process at stake and the HIA. In incremental or mixed model decision-making, use of HIA evidence by policy-makers is heavily dependent on their values in the context, which may result in conceptual utilization or may extend to strategic utilization. In rational decision-making, HIA provides information independent from the context, which results in instrumental utilization. HIA practitioners need to optimise utilization and produce an appropriate HIA by mapping the policy process. They can do this by asking the questions ‘What? How? Who? and What context? and by maintaining continuous communication with the decision-makers. An appropriate HIA is policy-, time- and place-specific: reflecting the decision-making of the policy at stake. Furthermore, HIA concerns two policy fields with two different contexts and, in some cases, two different decision-making models. The administrative requirements for an appropriate HIA need further exploration.