The Triangular Relationship between the Commission, NRAs and National Courts Revisited

In this article, the authors review the relationship between the Commission, the national regulatory authorities (NRAs) and national courts in light of the Commission's proposals for reform as laid out in the 2006 Review. They focus upon the Article 7 and Article 4 procedures of Directive 2002/21. They conclude that the Commission proposals leave key questions and their implications outside of discussion and fail to address core issues such as the standard of assessment under Article 7, the accountability for decisions taken upstream of the NRA, and the scope and depth of judicial review.Institutional framework; Article 7 procedure; accountability and judicial review

Curing the queue

Het is een geregeld onderwerp van gesprek: de kosten van de zorg in Nederland rijzen de pan uit. Met de vergrijzing wordt instandhouding van het huidige zorgniveau steeds moeilijker en onbetaalbaarder. Ook over wachtlijsten in de zorg wordt veelvuldig geklaagd — het efficiëntieniveau in de meeste ziekenhuizen lijkt te wensen over te laten. “Gezien wat er op het spel staat, is het moeilijk te begrijpen dat het in ziekenhuizen eerder regel dan uitzondering is om expliciete beslissingen over de verdeling van schaarse goederen en capaciteit te vermijden,” aldus Maartje Zonderland. Zij is na het afronden van de studies Technische Bedrijfskunde en Toegepaste Wiskunde in 2008 als adviseur bedrijfsvoering aan de slag gegaan bij het Leids Universitair Medisch Centrum (LUMC) en was daarnaast promovenda aan de Universiteit Twente. Op 27 januari 2012 promoveerde ze op het proefschrift Curing the Queue dat ze schreef onder begeleiding van prof.dr. Richard Boucherie (UT), dr. Nelly Litvak (UT) en dr. Fred Boer (LUMC)

Systematic Analysis of Rebound Effects for "Greening by ICT" Initiatives

The application of ICT can lead to considerable reductions in the energy consumption of society. Although ICT itself consumes energy, there are many good reasons to explore the possibilities of 'green ICT'. After decades of experiments and research, ICTs designed to be 'green' still holds the promise of leading to substantial ecological benefits by means of dematerialisation, more efficient production processes and changed (more sustainable) human behaviour. Up till now, the effects of ICT on energy consumption are much less straightforward due to rebound effects: effects that have a negative influence on the intended positive effect. In parallel, rebound effects themselves have in turn other side effects as well, so there are many interacting effects to account for, greatly adding to complexity of the discussion. Despite evidence that suggests otherwise, initiatives that focus on 'greening by ICT' do notaccount for a consistent analysis of these rebound effects. This paper proposes an approach that enables to map and analyze these rebound effects systematically. This approach is applied in two related cases, teleworking and the use of Smart Working Centres. The Rapid Assessment Program (RAP) is used as a simulation model to identify which chains of effects are most interesting to consider for intervention. The application in the two cases demonstrates that rebound effects can by structured and that the RAP is a very suitable way to do so and provides a good assessment of net sustainability effects.rebound effects, Rapid Assesment Program, greening by ICT, teleworking.

Anticoagulation in Atrial Fibrillation:Consideration for treatment and health economic aspects

Atrial fibrillation (AF) is the most common cardiac arrhythmia with an increased risk of stroke and mortality. Effective stroke prevention leads to an improved quality of life and a lower economic disease burden. Anticoagulants such as the oral vitamin K antagonist and non-vitamin K antagonist oral anticoagulants can be used to reduce the stroke risk. In this thesis, Maartje Jacobs describes different aspects of AF treatment with a focus on stroke prevention. The research emphasizes on disease detection, drug treatment and how to handle specific subgroups. This thesis captures the aspects that are relevant from a clinical perspective as well as a payer’s and societal perspective. Important factors in stroke prevention are early detection of AF using screening, optimized prescription of the oral anticoagulants and appropriate use by the patient. Jacobs showed in this thesis that screening for AF can be a cost-effective, and even cost-saving, approach to detect new patients and to initiate stroke prevention. Specific subgroups would require a tailored approach for stroke prevention. Subpopulations with more challenges in AF treatment are for example critically ill patients, patients undergoing surgery and patients with co-existing coronary artery disease. Jacobs concludes that healthcare should be delivered in a way that best fits the patient, meaning: individualized treatment choices to optimize the AF risk management leading to improved patient outcomes. Since stroke induces a high economic burden to society, AF detection and stroke prevention are a good starting point for healthcare optimization