Supplemental health insurance and equality of access in Belgium.

It has been suggested that the unequal coverage of different socio-economic groups by supplemental insurance could be a partial explanation for the inequality in access to health care in many countries. We analyse the situation in Belgium, a country with a very broad coverage in compulsory social health insurance and where supplemental insurance mainly refers to extra-billing in hospitals. We find that this institutional background is crucial for the explanation of the effects of supplemental insurance. We find no evidence of adverse selection in the coverage of supplemental health insurance, but strong effects of socio-economic background. A count model for hospital care shows that supplemental insurance has no significant effect on the number of spells, but a negative effect on the number of nights. This is in line with patterns of socio-economic stratification that have been well documented for Belgium. It is also in line with the regulation on extra-billing protecting patients in common rooms. For ambulatory care, we find a positive effect of supplemental insurance on visits to a dentist and on number of spells at a day centre but no effect on visits to a GP, on drugs consumption and on visits to a specialist.Costs; Cost; Risk; Policy; Choice; Insurance; Equality; Belgium;

Economic impact of port activity : a disaggregate analysis. The case of Antwerp

The economic impact of the port sector is usually measured at an aggregate level by indicators such as value added, employment and investment. This paper tries to define the economic relevance for the regional as well as for the national economy at a disaggregate level. It attempts to identify, quantify and locate the mutual relationships between the various port players themselves and between them and other Belgian industries. Due to a lack of information foreign trade is only tackled very briefly but the method outlined in this paper can be used to measure the national effects of changes in port activity at a detailed level. A sector analysis is made by compiling a regional (regional as geographically opposed to national, not to be mistaken for the Belgian Regions Brussels, Flanders and Wallonia) input-output table, resorting to microeconomic data: a bottom-up approach. The main customers and suppliers of the port's key players or stakeholders are identified. A geographical analysis can also be carried out by using data at a disaggregate level. Each customer or supplier can be located by means of their postcode. In so doing, the economic impact of the port is quantified, both functionally and geographically. In the case of the port of Antwerp, the results show important links between freight forwarders and agents. The geographical analysis suggests the existence of major agglomerating effects in and around the port of Antwerp, referred to as a major transhipment location point. Key words: port economics, regional input-output table, sector analysis, geographical analysis.port economics, regional input-output table, sector analysis, geographical analysis

Stimulating job crafting behaviors of older workers:The influence of opportunity-enhancing human resource practices and psychological empowerment

Since job crafting behaviour is of profound importance for the retention of older workers, we examined how organizations can stimulate job crafting behaviour among older workers with opportunity-enhancing Human Resource (HR) practices. We introduced three job crafting behaviours: accommodative, utilization, and developmental job crafting. We hypothesized that opportunity-enhancing HR practices increase psychological empowerment among older workers and therefore their job crafting behaviour. We conducted a survey study with two waves among 125 Dutch older workers (65+) affiliated with a temporary employment agency aiming to employ older workers and found that changes in perceptions of opportunity-enhancing HR practices are positively related to changes in psychological empowerment and, in turn, to changes in utilization and developmental crafting behaviours. Unexpectedly, changes in psychological empowerment were not associated with changes in accommodative crafting and changes in opportunity-enhancing HR practices perceptions were not directly associated with changes in job crafting behaviour. With this study, we contribute to the literature on job crafting and human resource management by showing that opportunity-enhancing HR practices influence job crafting behaviour through psychological empowerment

Wie betaalt supplementen in de Belgische gezondheidszorg?

Ondanks de genomen beschermingsmaatregelen (bv. de maximumfactuur) zijn de eigen betalingen voor gezondheidszorg van de patiënten gedurende de laatste jaren gestegen. Deze eigen betalingen bestaan uit remgelden en supplementen. In dit artikel onderzoeken we de sociale gevolgen van deze evolutie: we analyseren de omvang van de supplementen en vooral ook hun verdeling over de Belgische bevolking. De analyses gebeuren op basis van de administratieve gegevens van de terugbetalingen binnen de verplichte ziekteverzekering in 2003 voor een steekproef van 300.000 individuen. We vinden da

Radiolocalisation and imaging of stably HPLAP-transfected MO4 tumours with monoclonal antibodies and fragments.

Immunotargeting of PLAP-expressing tumours was studied for two radioiodinated, highly specific anti-PLAP monoclonal antibodies, 7E8 and 17E3, differing 10-fold in affinity, as well as for 7E8 F(ab')2 fragments. An anti-CEA monoclonal antibody or anti-CD3 F(ab')2 fragments were used as controls. Specific and non-specific targeting was examined in nude mice simultaneously grafted with PLAP-positive tumours derived from MO4 1-4 cells, and CEA-positive tumours, derived from 5583-S cells. Results indicated that (1) MO4 1-4 tumours, with a stable expression of PLAP on the plasma membrane, represent a useful new in vivo model for immunodirected tumour targeting; (2) differences in antibody affinity for PLAP in vitro are not reflected in antibody avidity for tumour cells in vivo; and (3) excellent selective and specific localisation of the PLAP-positive tumours is achieved when 7E8 F(ab')2 fragments are used. The high tumour/blood ratios (10.7 +/- 3.9 at 46 h after injection) were due to a much faster blood clearance of 7E8 F(ab')2 fragments. At this time point, the mean tumour/non-tumour tissue ratio was as high as 34.5, and the mean specific localisation index was 29.0. As expected, the F(ab')2 fragments provided high tumour imaging efficiency on gamma camera recording. These data imply important potentials of the PLAP/anti-PLAP system for immunolocalisation and therapy in patients, but also emphasise that in vitro criteria alone are not reflected in in vivo tumour localisation capacities of antibodies

Ferulic acid-4-O-sulfate rather than ferulic acid relaxes arteries and lowers blood pressure in mice

Consumption of foods rich in ferulic acid (FA) such as wholegrain cereals, or FA precursors such as chlorogenic acids in coffee, is inversely correlated with risk of cardiovascular disease and type 2 diabetes. As a result of digestion and phase II metabolism in the gut and liver, FA is converted predominantly into ferulic acid-4-O-sulfate (FA-sul), an abundant plasma metabolite. Although FA-sul may be the main metabolite, very little has been reported regarding its bioactivities. We have therefore compared the ex vivo vasorelaxing effect of FA and FA-sul (10−7 - 3.10−5 M) on isolated mouse arteries mounted in tissue myographs. FA-sul, but not FA, elicited a concentration-dependent vasorelaxation of saphenous and femoral arteries and aortae. The FA-sul mediated vasorelaxation was blunted by 1H- [1, 2, 4]oxadiazolo[4,3-a]quinoxalin-1-one (ODQ), a soluble guanylate cyclase (sGC) inhibitor. The role of sGC was confirmed in femoral arteries isolated from sGCα1(−/−) knockout mice. Furthermore, 4-aminopyridine, a specific inhibitor of voltage-dependent potassium channels, significantly decreased FA-sul mediated effects. In anesthetized mice, intravenous injection of FA-sul decreased mean arterial pressure, whereas FA had no effect, confirming the results obtained ex vivo. FA-sul is probably one of the major metabolites accounting for the blood pressure-lowering effects associated with FA consumption

Подсистема автономного программно-аппаратного комплекса для индуктивного долгосрочного прогноза осредненных значений метеопараметров

The research of the inductive method of long-term (forestalling to 0,5 year) prognosis of average decade air s temperature on the basis of principle of analogies was executed and it s sufficient was shown. The research of the offered approach was also conducted: in the base of spatial models without principle of analogies; in the polynomial harmonic base; the analysis of middle quality of the inductive prognostic method for cases of the analogue principle usage and without it

Patient socioeconomic determinants for the choice of the cheapest molecule within a cluster: evidence from Belgian prescription data

Reference pricing is a common cost-sharing mechanism, with the financial penalty for the use of costly drugs shifted from the third-party payer to the patient. Unintended distributional consequences might arise, if the weakest socioeconomic groups face a relatively higher financial burden. This study analyzed for a sample of Belgian individual prescription data for 4 clusters of commonly used drugs (proton pump inhibitors, statins and two groups of antihypertensives [drugs acting on renin-angiotensin system and dihydropyridine derivatives]) whether the probability to receive the least expensive molecule within a cluster was linked to the socioeconomic status of the patient. Logistic regression models included individual demographic, working, chronic illness and financial status and small area education data for 906,543 prescriptions from 1,280 prescribing general practitioners and specialists. For the 4 clusters, results show that patients with lower socioeconomic status consistently use slightly more the least expensive drugs than other patients. Larger effects are observed for patients residing in a nursing home for the elderly, patients entitled to increased reimbursement of co-payments, unemployed, patients treated in a primary care center financed per capita (and not fee-for-service) and patients having a chronic illness. Also, patients residing in neighborhoods with low education status use more less expensive drugs. The findings of the study suggest that although equity considerations were not explicitly taken into account in the design of the reference price system, there is no real equity problem, as the costly drugs with supplement are not prescribed more often in patients from lower socioeconomic classes