Higher education reform: getting the incentives right

This study is a joint effort by the Netherlands Bureau for Economic Policy Analysis (CPB) and the Center for Higher Education Policy Studies. It analyses a number of `best practices¿ where the design of financial incentives working on the system level of higher education is concerned. In Chapter 1, an overview of some of the characteristics of the Dutch higher education sector is presented. Chapter 2 is a refresher on the economics of higher education. Chapter 3 is about the Australian Higher Education Contribution Scheme (HECS). Chapter 4 is about tuition fees and admission policies in US universities. Chapter 5 looks at the funding of Danish universities through the so-called taximeter-model, that links funding to student performance. Chapter 6 deals with research funding in the UK university system, where research assessments exercises underlie the funding decisions. In Chapter 7 we study the impact of university-industry ties on academic research by examining the US policies on increasing knowledge transfer between universities and the private sector. Finally, Chapter 8 presents food for thought for Dutch policymakers: what lessons can be learned from our international comparison

Individual patient data meta-analysis of randomized controlled trials of community occupational therapy for stroke patients

<p><b>Background and Purpose:</b> Trials of occupational therapy for stroke patients living in the community have varied in their findings. It is unclear why these discrepancies have occurred.</p> <p><b>Methods:</b> Trials were identified from searches of the Cochrane Library and other sources. The primary outcome measure was the Nottingham Extended Activities of Daily Living (NEADL) score at the end of intervention. Secondary outcome measures included the Barthel Index or the Rivermead ADL (Personal ADL), General Health Questionnaire (GHQ), Nottingham Leisure Questionnaire (NLQ), and death. Data were analyzed using linear or logistic regression with a random effect for trial and adjustment for age, gender, baseline dependency, and method of follow-up. Subgroup analyses compared any occupational therapy intervention with control.</p> <p><b>Results:</b> We included 8 single-blind randomized controlled trials incorporating 1143 patients. Occupational therapy was associated with higher NEADL scores at the end of intervention (weighted mean difference [WMD], 1.30 points, 95% confidence intervals [CI], 0.47 to 2.13) and higher leisure scores at the end of intervention (WMD, 1.51 points; 95% CI, 0.24 to 2.79). Occupational therapy emphasizing activities of daily living (ADL) was associated with improved end of intervention NEADL (WMD, 1.61 points; 95% CI, 0.72 to 2.49) and personal activities of daily living (odds ratio [OR], 0.65; 95% CI, 0.46 to 0.91), but not NLQ. Leisure-based occupational therapy improved end of intervention NLQ (WMD, 1.96 points; 95% CI, 0.27 to 3.66) but not NEADL or PADL.</p> <p><b>Conclusions:</b> Community occupational therapy significantly improved personal and extended activities of daily living and leisure activity in patients with stroke. Better outcomes were found with targeted interventions.</p&gt

The influence of achievement before, during and after medical school on physician job satisfaction

In this longitudinal study, we investigated the relationship between physicians' prior achievements (before, during and after medical school) and job satisfaction, and tested the two lines of reasoning that prior achievements influence job satisfaction positively or negatively, respectively. The participants were graduates who started their medical training in 1982 (n = 147), 1983 (n = 154), 1992 (n = 143) and 1993 (n = 153). We operationalised job satisfaction as satisfaction (on a 10-point scale) with 13 cognitive, affective and instrumental aspects of the participants' jobs. The measures of achievement before, during and after medical school included pre-university grade point average, study progress and a residency position in the specialty of first choice, respectively. We included the effect of curriculum type (problem-based learning versus traditional), gender and years of experience as moderator variables. Higher achievers before and during medical school were more satisfied about their income (beta = .152, p &lt;.01 and beta = .149, p &lt;.05), but less satisfied with their opportunities for personal development (beta = -.159, p &lt;.05). High achievers after medical school were more satisfied with professional accomplishments (beta = .095, p &lt;.05), with appreciation from support personnel (beta = .154, p &lt;.01) and from patients (beta = .120, p &lt;.05). Effect sizes were small. Prior achievements influenced job satisfaction. The direction of the influences depended on the job satisfaction aspect in question, which indicates that it is important to distinguish between aspects of job satisfaction. To optimize job satisfaction of high achievers, it is important for graduates to obtain their preferred specialty. Furthermore, it is vital to provide them with enough opportunities for further development.</p