Uitkomstbekostiging in de zorg: een (on)begaanbare weg?

__Abstract__ In veel landen – waaronder Nederland – groeien de zorgkosten sterker dan de economie, schiet de kwaliteit van zorg op diverse punten tekort, en duidt praktijkvariatie op ruimte voor het verhogen van de doelmatigheid van zorg. Inadequate bekostigingssystemen en de gebrekkige transparantie van de kwaliteit van zorg worden vaak genoemd als belangrijke oorzaken van deze problemen. Zo was een belangrijke conclusie van de recente evaluatie van het zorgstelsel dat het bij zorgaanbieders vaak nog ontbreekt aan financiële prikkels voor kwaliteit en doelmatigheid

Oligotrophy and pelagic marine bacteria:Facts and fiction

Oligotrophy, or the inability of bacterial cells to propagate at elevated nutrient concentrations, is a controversial phenomenon in microbiology. The exact cause of the unculturability of many indigenous marine bacteria on standard laboratory media has still not been resolved. Unfortunately the physiology of such cells is difficult to investigate as long as high cell density cultures cannot be obtained. An extensive evaluation of experiments relating to oligotrophy and the cultivation of marine bacteria is presented in this review. When incorporating the findings of studies performed with molecular biological methods, the picture emerges that indigenous marine bacteria can be cultivated under certain conditions and that the 'oligotrophic way of life' is a transient characteristic. Although strong generalisations should not be made with respect to a biological system as diverse as the world's oceans, it should be anticipated that cells with unique physiological characteristics appear to exist in the oceanic system. When combining conventional physiological approaches with molecular biological techniques it is feasible to unveil the phenotypes that go with the encountered genotypes. In view of the enormous complexity of the oceanic system this will prove an ambitious, yet resourceful undertaking

Evaluatie aanvullende en collectieve verzekeringen 2008

In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijke gevolgen van aanvullende en collectieve verzekeringen voor risicoselectie en verzekerdenmobiliteit in de basisverzekering. De analyse heeft betrekking op het jaar 2008. Tevens worden de ontwikkelingen in 2008 vergeleken met de bevindingen van voorafgaande evaluatiestudies over eerdere jaren. Het onderzoek is uitgevoerd in opdracht van de Nederlandse Patiënten Consumenten Federatie (NPCF)

Evaluatie aanvullende en collectieve ziektekostenverzekeringen 2009

Voorwoord In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijke gevolgen van aanvullende en collectieve verzekeringen voor risicoselectie en verzekerdenmobiliteit in de basisverzekering. De analyse heeft betrekking op het jaar 2009. Tevens worden de ontwikkelingen in 2009 vergeleken met de bevindingen van evaluatiestudies over eerdere jaren. Het onderzoek is uitgevoerd in opdracht van de Nederlandse Patiënten Consumenten Federatie (NPCF). De auteurs danken prof. dr. W.P.M.M. van de Ven voor zijn waardevolle commentaar op een eerdere versie van dit rapport. Tevens danken zij drs. P.J. Schout van de NPCF voor haar inzet voor de totstandkoming van dit onderzoeksproject en haar betrokkenheid en commentaar

Identifying prognostic factors for clinical outcomes and costs in four high-volume surgical treatments using routinely collected hospital data

Identifying prognostic factors (PFs) is often costly and labor-intensive. Routinely collected hospital data provide opportunities to identify clinically relevant PFs and construct accurate prognostic models without additional data-collection costs. This multicenter (66 hospitals) study reports on associations various patient-level variables have with outcomes and costs. Outcomes were in-hospital mortality, intensive care unit (ICU) admission, length of stay, 30-day readmission, 30-day reintervention and in-hospital costs. Candidate PFs were age, sex, Elixhauser Comorbidity Score, prior hospitalizations, prior days spent in hospital, and socio-economic status. Included patients dealt with either colorectal carcinoma (CRC, n = 10,254), urinary bladder carcinoma (UBC, n = 17,385), acute percutaneous coronary intervention (aPCI, n = 25,818), or total knee arthroplasty (TKA, n = 39,214). Prior hospitalization significantly increased readmission risk in all treatments (OR between 2.15 and 25.50), whereas prior days spent in hospital decreased this risk (OR between 0.55 and 0.95). In CRC patients, women had lower risk of in-hospital mortality (OR 0.64), ICU admittance (OR 0.68) and 30-day reintervention (OR 0.70). Prior hospitalization was the strongest PF for higher costs across all treatments (31–64% costs increase/hospitalization). Prognostic model performance (c-statistic) ranged 0.67–0.92, with Brier scores below 0.08. R-squared ranged from 0.06–0.19 for LoS and 0.19–0.38 for costs. Identified PFs should be considered as building blocks for treatment-specific prognostic models and information for monitoring patients after surgery. Researchers and clinicians might benefit from gaining a better insight into the drivers behind (costs) prognosis

Application of Raman Microspectroscopic and Raman imaging techniques for cell biological studies

Raman spectroscopy is being used to study biological molecules for some three decades now. Thanks to continuing advances in instrumentation more and more applications have become feasible in which molecules are studied in situ, and this has enabled Raman spectroscopy to enter the realms of biomedicine and cell biology [1-5].\ud Here we will describe some of the recent work carried out in our laboratory, concerning studies of human white blood cells and further instrumentational developments

Nanocavity formation processes in MgO(100) by light ion (D, He, Li) and heavy ion (Kr, Cu, Au) implantation

In studies on the controlled growth of metallic precipitates in MgO it is attempted to use nanometer size cavities as precursors for formation of metallic precipitates. In MgO nanocavities can easily be generated by light gas ion bombardment at room temperature with typically 30 keV ion energy to a dose of 10^16 cm–2, followed by annealing to 1300 K. It has been shown earlier by transmission electron microscopy (TEM) that the cavities (thickness 2–3 nm and length/width 5–10 nm) have a perfectly rectangular shape bounded by {100} faces. The majority of the gas has been released at this temperature and the cavities are stable until annealing at 1500 K. The depth location of the cavities and the implanted ions is monitored by positron beam analysis, neutron depth profiling, RBS/channeling and energy dispersive spectroscopy. The presence of metallic nanoprecipitates is detected by optical absorption measurements and by high-resolution XTEM. Surprisingly, all the metallic implants induce, in addition to metallic precipitates in a band at the mean ion range, small rectangular and cubic nanocavities. These are most clearly observed at a depth shallower than the precipitate band. In the case of gold the cavities are produced in close proximity to the crystal surface. The results indicate that in MgO vacancy clustering dominates over Frenkel-pair recombination. Results of molecular dynamics calculations will be used to discuss the observed defect recovery and clustering processes in MgO

Increased prevalence of abnormal vertebral patterning in fetuses and neonates with trisomy 21

Purpose: To assess the prevalence of an abnormal number of ribs in a cohort of fetuses and neonates with trisomy 21 and compare this with a subgroup of fetuses without anomalies. Materials and methods: Radiographs of 67 deceased fetuses, neonates, and infants that were diagnosed with trisomy 21 were reviewed. Terminations of pregnancy were included. The control group was composed of 107 deceased fetuses, neonates, and infants without known chromosomal abnormalities, structural malformations, infections or placental pathology. Cases in which the number of thoracic ribs or presence of cervical ribs could not be reliably assessed were excluded. The literature concerning vertebral patterning in trisomy 21 cases and healthy subjects was reviewed. Results: Absent or rudimentary 12th thoracic ribs were found in 26/54 (48.1%) cases with trisomy 21 and cervical ribs were present in 27/47 (57.4%) cases. This prevalence was significantly higher compared to controls (28/100, 28.0%, Χ2(1) = 6.252, p = .012 and 28/97, 28.9%, Χ2(1) = 10.955, p < .001, respectively). Conclusions: Rudimentary or absent 12th thoracic ribs and cervical ribs are significantly more prevalent in deceased fetuses and infants with trisomy 21

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

textabstractThere is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores