Investigating spatial concentration of sustainable restaurants:It is all about good food!

This research addresses the role of sustainable demand and psychological and cultural factors in the spatial concentration of sustainable SMEs. We analyze the spatial concentration of sustainable SMEs in the restaurant sector in the Netherlands. We argue that traditional agglomeration theories can partially explain spatial concentration of sustainable SMEs, but are not sufficient in explaining the sub-sector concentration of sustainable entrepreneurs. Demand, psychological and cultural factors could explain sub-sector concentration of sustainable restaurants. We use sustainable entrepreneurship theory to explain this difference. We analyze spatial concentration of sustainable SMEs in three ways. First, we investigate spatial concentration based on all individual locations of sustainable restaurants with an average nearest neighbor analysis. Second, we analyze spatial autocorrelation with use of the Moran's I statistic. Finally, we map the clustering of sustainable restaurants with a Getis-Ord Gi* analysis. We use sustainable restaurants as a percentage of conventional restaurants in a region in the Netherlands. While controlling for conventional clustering, we find a single large cluster of sustainable restaurants. Arguably, this clustering is caused by a spatial variation of demand and individual psychological traits of sustainable entrepreneurs, which together represent a regional culture of sustainable entrepreneurship

Het Woogle Woo-dossiercorpus

De Woo is nu anderhalf jaar van kracht en leidt tot steeds meer actieve publicatie van documenten door de bestuursorganen die onder de Woo vallen. Met Woogle worden die documenten herbruikbaar. Documenten van een breed palet aan bestuursorganen worden verzameld en voorzien van uitgebreide gestandaardiseerde metadata.Woogle is een platform ontwikkeld aan de Universiteit van Amsterdam dat beoogt op één plek alle documenten die zijn vrijgegeven onder de Wet Open Overheid (Woo) vanuit alle bestuursorganen die onder de Woo vallen samen te brengen. Woogle is hierin vergelijkbaar met het informatieregister,3uit een eerdere versie van de Woo, wat later afgezwakt werd tot het Platform Open Overheidsinformatie (PLOOI), dat na het BIT-advies van eind 20224nog verder is afgezwakt tot de Woo-index. De term ‘informatieregister’ lijkt tijdens de behandeling van de Woo besmet geraakt. Dit kwam doordat het idee nooit is uitgewerkt en een centrale en directe toegang tot alle documenten van de hele overheid als onhaalbaar en zeer kostbaar is ingeschat.5De Woo is nu anderhalf jaar van kracht en moet leiden tot steeds meer actieve publicatie van documenten door de bestuursorganen die onder de Woo vallen

The use of quality information by general practitioners: does it alter choices? A randomized clustered study

Background: Following the introduction of elements of managed competition in the Netherlands in 2006, General Practitioners (GPs) and patients were given the role to select treatment hospital using public quality information. In this study we investigate to what extent hospital preferences of GP's are affected by performance indicators on medical effectiveness and patient experiences. We selected three conditions: breast cancer, cataract surgery, and hip and knee replacement. Methods. After an inquiry 26 out of 226 GPs in the region signed up to participate in our study. After a 2:1 randomization, we analyzed the referral patterns in the region using three groups of GPs: GPs (n=17) who used the report cards and received personal clarification, GPs that signed up for the study but were assigned to the control group (n=9), and the GPs outside the study (n=200).We conducted a difference in differences analysis where the choice for a particular hospital was the dependent variable and time (2009 or 2010), the sum score of the CQI, the sum score of the PI's and dummy variables for the individual hospitals were used as independent variables. Results: The analysis of the conditions together and cataract surgery and hip and knee replacement separately, showed no significant relationships between the scores on the report cards and the referral patterns of the GPs. For breast cancer our analysis revealed that GPs in the intervention group refer 1.0% (p=0.01) more to hospitals that score one percent point better on the indicators for medical effectiveness. Conclusion: Our study provides empirical evidence that GP referral patterns were unaffected by the available quality information, except for the outcome indicators for breast cancer care that were presented. This finding was surprising since our study was designed to identify changes in hospital preference (1) amongst the most motivated GP's, (2) that received personal clarification of the performance indicators, and (3) selected indicators/conditions from a large set of indicators that they believed were most important. This finding may differ when quality information is based on outcome indicators with a clinically relevant difference, as shown by our indicators for breast cancer treatment. We believe that the current set of (largely process) hospital quality indicators do not serve the GP's information needs and consequently quality plays little role in the selection of hospitals for treatment. © 2013 Ikkersheim and Koolman; licensee BioMed Central Ltd

Dutch healthcare reform: did it result in better patient experiences in hospitals? a comparison of the consumer quality index over time

<p>Abstract</p> <p>Background</p> <p>In 2006, the Dutch hospital market was reformed to create a more efficient delivery system through managed competition. To allow competition on quality, patient experiences were measured using the Consumer Quality index (CQI). We study whether public reporting and competition had an effect on the CQI between 2006 and 2009.</p> <p>Methods</p> <p>We analyzed 8,311 respondents covering 31 hospitals in 2006, 22,333 respondents covering 78 hospitals in 2007 and 24,246 respondents covering 94 hospitals in 2009. We describe CQI trends over the period 2006-2009. In addition we compare hospitals that varied in the level of competition they faced and hospitals that were forced to publish CQI results publicly and those that were not. We corrected for observable covariates between hospital respondents using a multi level linear regression. We used the Herfindahl Hirschman Index to indicate the level of competition.</p> <p>Results</p> <p>Between 2006 and 2009 hospitals showed a CQI improvement of 0.034 (p < 0.05) to 0.060 (p < 0.01) points on a scale between one and four. Hospitals that were forced to publish their scores showed a further improvement of 0.027 (p < 0.01) to 0.030 (p < 0.05). Furthermore, hospitals that faced more competition from geographically close competitors showed a more pronounced improvement of CQI-scores 0.004 to 0.05 than other hospitals (p < 0.001).</p> <p>Conclusion</p> <p>Our results show that patients reported improved experiences measured by the CQI between 2006 and 2009. CQI levels improve at a faster rate in areas with higher levels of competition. Hospitals confronted with forced public publication of their CQI responded by enhancing the experiences of their patients.</p

How to Argue about Health Care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68919/2/10.1177_107755878704400102.pd

The Refederalization of American Health Care

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69090/2/10.1177_107755878704400103.pd

Market structure and hospital–insurer bargaining in the Netherlands

In 2005, competition was introduced in part of the hospital market in the Netherlands. Using a unique dataset of transactions and list prices between hospitals and insurers in the years 2005 and 2006, we estimate the influence of buyer and seller concentration on the negotiated prices. First, we use a traditional structure–conduct–performance model (SCP-model) along the lines of Melnick et al. (J Health Econ 11(3): 217–233, 1992) to estimate the effects of buyer and seller concentration on price–cost margins. Second, we model the interaction between hospitals and insurers in the context of a generalized bargaining model similar to Brooks et al. (J Health Econ 16: 417–434, 1997). In the SCP-model, we find that the market shares of hospitals (insurers) have a significantly positive (negative) impact on the hospital price–cost margin. In the bargaining model, we find a significant negative effect of insurer concentration, but no significant effect of hospital concentration. In both models, we find a significant impact of idiosyncratic effects on the market outcomes. This is consistent with the fact that the Dutch hospital sector is not yet in a long-run equilibrium

"Liberalizing" the English National Health Service: background and risks to healthcare entitlement

Resumo: A recente reforma do Serviço Nacional de Saúde (NHS) inglês por meio do Health and Social Care Act de 2012 introduziu mudanças importantes na organização, gestão e prestação de serviços públicos de saúde na Inglaterra. O objetivo deste estudo é analisar as reformas do NHS no contexto histórico de predomínio de teorias neoliberais desde 1980 e discutir o processo de "liberalização" do NHS. São identificados e analisados três momentos: (i) gradativa substituição ideológica e teórica (1979-1990) - transição da lógica profissional e sanitária para uma lógica gerencial/comercial; (ii) burocracia e mercado incipiente (1991-2004) - estruturação de burocracia voltada à administração do mercado interno e expansão de medidas pró-mercado; e (iii) abertura ao mercado, fragmentação e descontinuidade de serviços (2005-2012) - fragilização do modelo de saúde territorial e consolidação da saúde como um mercado aberto a prestadores públicos e privados. Esse processo gradual e constante de liberalização vem levando ao fechamento de serviços e à restrição do acesso, comprometendo a integralidade, a equidade e o direito universal à saúde no NHS