The spatial dimension of social capital

Social capital pertains to the social relations between humans, and since these social relations have a spatial dimension, so too does social capital. However, the spatial dimension of social capital has received little attention in the literature so far. Even in a globalizing world where electronic and virtual communication have the potential to defeat the need for geographical proximity, it is still relevant to consider the spatial dimension of social capital. After all, human beings exist most prominently in real rather than in virtual space. This special issue undertakes an inquiry into the spatial dimension of social capital from an explorative perspective. It aims to further theoretical and empirical understanding of the spatial dimension of social capital. As editors we recognize that the debate on social capital is still ongoing in the literature and that it is fed from different, sometimes conflicting perspectives. Therefore, the spatial dimension of social capital can only be conceptualized in the light of these different perspectives, which necessitates an explorative approach. Nonetheless, the various contributions of this special issue allow several conclusions that are valuable to the ongoing discussion on social capital and its spatial dimension. In the first part of this introductory paper, we discuss social capital from a conceptual angle, as we distinguish between two key approaches (the “structuralist” and “interactionist” approaches). We then argue how these approaches may be helpful to the understanding of the spatial dimension of social capital. In the second part, we introduce the various contributions and explain how they contribute to the aim of this special issue.Social capital; Spatial social capital; Spatial social networks

Economic appraisal of asthma and COPD care: A literature review 1980–1991

Despite the considerable burden and costs of illness and despite the increasing need to set priorities on the basis of efficiency considerations, only 20 economic appraisals of asthma and COPD care have been published during the past 11 years. This paper provides a detailed summary of the cost-effectiveness ‘evidence’ given by these studies and a discussion of relevant methodological issues. The studies comparing programme costs of delivery methods for oxygen and for aerosol bronchodilator drugs, provide the most straightforward evidence in favour of the concentrator and the metered dose inhaler respectively. There also seems to be evidence in favour of hospital-based home care programmes as compared to community-based home care programs. Health education, especially directed at asthmatic children seems to reduce health care costs and improve attitude, compliance behaviour and self-management skills. Information on the cost-effectiveness of pharmacotherapy and diagnostic technologies, both important interventions in asthma and COPD, was found to be totally lacking

The Swiss and Dutch Health Insurance Systems: Universal Coverage and Regulated Competitive Insurance Markets

Compares systems of universal insurance coverage based on individual mandates, consumer choice of health plans, and regulated insurance market competition in Switzerland and the Netherlands. Discusses insights and implications for U.S. reform efforts

Gezondheidseconomie: de sleutel tot gepaste zorg The Impact of economic evaluation on healthcare decision-making

Afscheidscollege Professor Frans Rutten op 4 oktober 2012. Gezondheidseconomie, ofwel ‘health economics’, is een fascinerend deel - terrein van de economie dat gemakkelijk 40 jaar lang kan boeien. Dat geldt zeker als je, zoals ik, bij de start en ontwikkeling ervan nauw betrokken bent geweest. Het vakgebied is in deze 40 jaar gegroeid van een onbeduidend wetenschapsgebied tot een belangrijke en relevante subdiscipline van de economie, gemeten naar zowel wetenschappelijke output als maatschappelijke impact (Wagstaff en Culyer 2012). De onderwerpen, die in de loop der tijd door gezondheidseconomen onder de loep zijn genomen, variëren van macro-vraagstukken over de ordening van de zorg tot de bepaling van de kosten en baten van individuele programma’s, en van vraagstukken in Europa en de VS tot die m.b.t. de zorg Afrika en Azië. Op al die terreinen spelen we in Rotterdam een voortrekkersrol, zoals ook blijkt uit het feit dat wij gemeten naar wetenschappelijke output het 11e instituut in de wereld zijn en het 2e in Europa

Portfolio Theory and Cost-Effectiveness Analysis: A Further Discussion

AbstractObjectivesPortfolio theory has been suggested as a means to improve the risk–return characteristics of investments in health-care programs through diversification when costs and effects are uncertain. This approach is based on the assumption that the investment proportions are not subject to uncertainty and that the budget can be invested in toto in health-care programs.MethodsIn the present paper we develop an algorithm that accounts for the fact that investment proportions in health-care programs may be uncertain (due to the uncertainty associated with costs) and limited (due to the size of the programs). The initial budget allocation across programs may therefore be revised at the end of the investment period to cover the extra costs of some programs with the leftover budget of other programs in the portfolio.ResultsOnce the total budget is equivalent to or exceeds the expected costs of the programs in the portfolio, the initial budget allocation policy does not impact the risk–return characteristics of the combined portfolio, i.e., there is no benefit from diversification anymore.ConclusionThe applicability of portfolio methods to improve the risk–return characteristics of investments in health care is limited to situations where the available budget is much smaller than the expected costs of the programs to be funded

Kosten en effecten van esomeprazol in de behandeling van reflux ziekte

Doel. Het bepalen van de kosten-effectiviteit van esomeprazol (Nexium(r)) ten opzichte van alle andere in Nederland geregistreerde protonpomp remmers in de behandeling van reflux ziekte. Voor de effectiviteit vormt het hebben van voldoende controle over de symptomen het uitgangspunt. Perspectief. De studie is uitgevoerd zowel vanuit het perspectief van de verzekeraars als vanuit het maatschappelijk perspectief. Methoden. Gegevens met betrekking tot effectiviteit zijn afgeleid uit een systematische analyse van de literatuur. Gegevens omtrent zorgconsumptie zijn afkomstig uit interviews met huisartsen en gastro-enterologen. Een model is ontwikkeld, dat de gegevens over effectiviteit en kosten van behandeling bijeen brengt. De structuur van het model is vervolgens bediscussieerd met een panel van deskundigen. Tenslotte zijn de berekeningen uitgevoerd met het aangepaste model. Resultaten. Behandeling met esomeprazol 40 mg is dominant ten opzichte van de andere protonpomp remmers: 96,4% van de patiënten heeft na 8 weken voldoende controle over de klachten, tegen totale kosten van EUR 89 (maatschappelijk;m) / EUR 83 (verzekeraar;v). Na esomeprazol 40 mg is omeprazol 40 mg het meest effectief (95,2%), gevolgd door esomeprazol 20 mg (94%)

Welfarism vs. extra-welfarism

'Extra-welfarism' has received some attention in health economics, yet there is little consensus on what distinguishes it from more conventional 'welfarist economics'. In this paper, we seek to identify the characteristics of each in order to make a systematic comparison of the ways in which they evaluate alternative social states. The focus, though this is not intended to be exclusive, is on health. Specifically, we highlight four areas in which the two schools differ: (i) the outcomes considered relevant in an evaluation; (ii) the sources of valuation of the relevant outcomes; (iii) the basis of weighting of relevant outcomes and (iv) interpersonal comparisons. We conclude that these differences are substantive. (C) 2007 Elsevier B.V. All rights reserved

Cost analysis and substitution of conventional treatment by autologous bone marrow transplantation for patients with (non) Hodgkin's lymphoma or acute myeloid leukemia

In a retrospective study we calculated the costs of introducing autologous BMT in the treatment of patients with malignant lymphoma and acute leukaemia in The Netherlands. The cost analysis has been performed in five university hospitals and one cancer centre, in a series of patients with intermediate and high grade non-Hodgkin's lymphoma (NHL) and patients with AML. Conventional treatment consisted of chemotherapy. The average costs of the conventional NHL treatment varied from US$3120 to U$12,900. The costs of autologous BMT amounted to US$40,220. In the AML group the costs of conventional treatment amounted to about US$11,040, as only 50% of the patients were treated further. The costs of autologous BMT including a follow-up period of 2 years, amounted to US$55,440. In The Netherlands the total number of autologous BMTs per year in these patient groups was estimated at 230; 180 in the NHL group and 50 in the AML group. The costs of introducing autologous BMT to the NHL group will vary between 4.93 and 6.68 million dollars and for the AML group these costs were estimated at 2.22 million dollars. As a result, the total extra costs of introducing autologous BMTs are expected to be between 7.15 and 8.9 million dollars