https://thesis.eur.nl/col/4312/ List of Publications en https://thesis.eur.nl/pub/4878/ Fri, 22 Aug 2008 00:00:01 GMT <div>Acker, Jorian van</div><div>Langenhoff, Wouter</div> Abstract ________________________________________ Since the Dutch health insurance market changed a few years ago, companies have to cope with new market characteristics. The main goal of the implementation of a standard base health insurance was to increase competition on the health insurance market. Now, more then two years later, it is interesting to see how both consumers and companies have adapted to the new situation. This thesis is a research on both the consumer decision process for choosing a health insurance and also an analysis of how Dutch health insurers deal with the given situation. Research is done by questionnaire under students and an interview with the largest health insurer in The Netherlands. Goal of this research is to analyse the consumer decision process and to learn in which way this process differs from other decision processes. Next to that, the study tries to learn which strategies health insurance companies apply in order to reach their targets and to assess how they adapt to the characteristics of both the market as well as the consumers. Results of the questionnaire show that the consumer decision process for choosing a health insurance is in line with theoretical expectations. While criteria for making a choice differ from mobile phone operators and health insurances, there seems to be a consistency among respondents. The respondents seem to have little knowledge about health insurance products and a large number of them is not the decision maker, but lets someone else decide (and pay) for them. Secondly, results of the interview show that health insurance companies apply all major theoretical strategies around pricing, segmentation and marketing. Insurers seem to be well aware of the characteristics of the market and the consumer decision process and have well adapted their strategy accordingly. Analysis of questionnaire and interview results shows that there are still possibilities for insurers in terms of reaching less informed consumers better and targeting decision makers better. https://thesis.eur.nl/pub/5545/ Thu, 01 Jan 2009 00:00:01 GMT <div>Demarteau, M</div> 1. Introduction From 1941 until 2006 the Dutch health care system experienced numerous reforms in an attempt to (a) ensure universal coverage and equal access, (b) contain cost and (c) improve efficiency. Although, each phase of reform had known its successes, the systems’ structure during that period did not support the achievement of the three goals simultaneously. Notwithstanding, these years of reform did produce valuable insights and as such they led to the belief that managed competition would be able to produce the desired outcome. The rationales for the introduction of managed competition into this market are twofold: it generates efficiency incentives and it induces quality improvements in the health care sector (F.T. Schut and W.P.M.M. Van de Ven, 2005). These rationales eventually led to the enactment of the Health Insurance Act and the Market Regulation Act in 2006; the Dutch health care system as it is known today. One of the areas where the competition has been introduced is the health care insurance (HCI) market. This newly introduced competition implies that there exists one uniform basic insurance, mandatory for every Dutch resident over the age of 18, which is purchased through private HCI companies. Moreover, health care insurers are obliged to accept every applicant of basic insurance. In addition, consumers can buy their basic HCI contracts at their preferred insurer and they are allowed to change insurer annually. Consumers may choose to buy supplementary health insurance covering care that is not included in the basic insurance, but this supplementary insurance is not characterized by open-enrollment (Hamilton, G. J. A. 2008). However, of critical importance for the effectiveness of the introduced competition is sound decision making on the consumer side. This is defined as decisions that are based on both price and quality considerations (Hamilton, G. J. A. 2005). Moreover, as the insured have the opportunity to switch annually, it is essential for competitive effectiveness that these considerations are made each year. The choices made by the insured, whether they switch or not, will produce signals that convey their quality and price preferences to the HC insurers. These signals, in turn, allow HC insurers to purchase the appropriate health care and engage in selective health care purchasing. Thus, choices not based on the adequate considerations will hinder effective competition and as such distort the Dutch HC market. This is in line with the research of Kerssens and Groenewegen where they indicate that “low levels of switching may not provide adequate demand signals in a system of managed ERASMUS UNIVERSITY ROTTERDAM - 4- competition”. Here, appropriate demand signals are defined as the adequate reflections of the consumers price and quality preferences, generated through informed consumer choice. Although previous research has investigated the decision making process of the insured, no attempt has yet been made to investigate whether the Dutch insured have been considering these quality and price aspects yearly, after the new system has been introduced. Therefore, the objective of this paper is to analyze whether the Dutch insured that do not switch yearly consider the existing options with regard to their choice of health care insurer. The second section of this paper will explain the concept of managed competition and the role of the health care insurer in more detail. Furthermore, this section introduces literature that addresses decision-making behavior. In the third section each construct of the model will be specified, after which the results of the analysis will be presented. Subsequently, a discussion and implication of the results, the conclusion and possible limitations and suggestions for further research are provided. https://thesis.eur.nl/pub/5936/ Sat, 01 Aug 2009 00:00:01 GMT <div>Ramlal, K</div> The pharmaceutical industry is one the most profitable industries, but innovative companies are in a period where innovation seems to stagnate. The road to new drug development has become increasingly more complex due to regulations and rising costs. Estimates for the cost of one new FDA approved drug have risen from US$ 802 million in 2003 to US$ 1,318 billion in 2007. Not only drug development costs have increased, but also healthcare expenditure. If health expenditures continue to rise and no appropriate action is taken, governments might not be able to fund the healthcare needs of every individual. A possible action is the use of generics, therapeutically equivalent to branded drugs, but at a fraction of the costs. This helps the governments to contain healthcare costs. However generic firms, typically, do not aid to the development of new therapies and drug development of conditions to which there is no treatment available. Too abundant use of generics reduces the motivation for branded firms to innovate, as it would be harder to recoup investments. It might be that generics seize a share large enough to threaten innovation in the US pharmaceutical industry. Drug development cost has increased over the years, while the patent protection system -on which the pharmaceutical industry heavily relies- seems not keep up with current developments. As Governmental regulation continues to strongly promote usage of generics, pharmaceutical companies can combat generics through various marketing strategies and interfirm agreements, however this may not be enough to improve R&D productivity. https://thesis.eur.nl/pub/5939/ Sat, 01 Aug 2009 00:00:01 GMT <div>Mai, K.T.</div> In the Netherlands, the overall health of allochthonous people is comparably lower than the average Dutch citizen. Health inequality minimization has been on the agenda for decades. Various studies have researched the existence of health inequalities and the minimizing necessity, including and excluding the Netherlands in the analysis. However, there is limited empirical evidence available. The aim of this paper is to research and provide evidence on whether nationality or ethnicity has an explanatory role in health inequalities, by using the AVO2003 and the ESE-student survey. After using a logit model for a measure of self-assessed health and odds ratios for interpreting this model, our results indicate differences in perceived health amongst various ethnic groups in the Netherlands. Allochthonous individuals, especially non-western allochthonous people, report a lower level of self-assessed health than autochthonous individuals in the Netherlands. Further research focusing on the root causes of the existing health inequalities will facilitate its minimization. https://thesis.eur.nl/pub/7096/ Wed, 19 May 2010 00:00:01 GMT <div>Luczak, J.</div> The thesis investigates catastrophic and impoverishing out-of-pocket payments for pharmaceuticals in Poland. This is an interesting issue especially because the country’s inhabitants incur extensive drug expenditures, both as a result of high co-payment level as well as of incredibly popular OTC medicines. First of the investigated approaches assumes that OOP expenditures should not exceed a threshold, which is set at a chosen fraction of income. Second approach takes into account payments that cause “new” or deepen the existing poverty. We find that the incidence and intensity of catastrophic drug expenditures increased over years and that the poor are more likely to incur them. As for the impoverishment approach, we find that pharmaceutical spending do have an influence on the poverty level, however it is higher when we consider relative poverty line than when we analyze poverty in absolute terms. What is interesting, it seems that poverty caused by drug expenditure is very stable across years. Similar procedure, conducted on the sub-sample of retired an chronically ill people brings higher results for both approaches. https://thesis.eur.nl/pub/7472/ Thu, 08 Jul 2010 00:00:01 GMT <div>El Habhoubi, E.</div> Zowel consumenten als zorgaanbieders veroorzaken het negatieve effect van welvaartsverlies door de moral hazard. Eigen betalingen kunnen dit welvaartsverlies verminderen, zonder dat er negatieve gezondheidseffecten optreden bij de gemiddelde consument. Het hanteren van een gemiddeld eigen risico bij de relatief goedkopere medische diensten die onder de ambulante zorg vallen, kan een belangrijke rol spelen bij het ontzien van de verzekeraar van de kleinere zorgclaims. De consument die al vroeg in een periode een grote kans heeft op het overschrijden van het eigen risico, ervaart een lagere effectieve prijs dan de prijs die hij daadwerkelijk uit eigen zak moet betalen. Het gevolg hiervan is dat het effect van het eigen risico op het consumeren van zorg al vroeg in een periode sterk beperkt wordt dan wel verloren gaat. Met het oog op de vergrijzing zou een procentuele bijdrage van rond de 25 de consumptie van residentiële zorg aanzienlijk kunnen verminderen. Een averechtse werking van eigen betalingen kan echter zijn dat de zorgaanbieder een prikkel heeft om de vraag te induceren, althans als hij een vergoeding per behandeling ontvangt. Hij zal naar verwachting meer diensten aanbevelen om zijn verlies aan inkomen te compenseren. Een manier om dit te reduceren is het hanteren van een vast betalingssysteem, waarbij de zorgaanbieder een vast bedrag ontvangt ongeacht het aantal geleverde diensten. https://thesis.eur.nl/pub/7789/ Mon, 16 Aug 2010 00:00:01 GMT <div>Stevens, L</div> 1. Introduction In many developed countries, increasing the number of donors and thereby decreasing waiting lists for donor organs is an important subject on the health policy agenda as organ transplantation is an important, and sometimes even the only, option to treat organ failures (Cameron and Forsythe, 2001). Donor organs can save lives, but supply cannot keep up with demand, creating and increasing waiting lists. Still, when comparing cadaveric donation rates of different countries, large differences exist. The Netherlands for example, had a cadaveric donation rate of 13 donors per million people in 2009, while neighbouring country Belgium had 25 cadaveric donors per million people; meaning Belgium had more than two times as much cadaveric donors per million inhabitants than the Netherlands last year (Transplant procurement management, 2010). This implies it might be instructive to look the way to deal with this problem of other countries when trying to increase donation rates. But it also raises questions on what determinants are actually influencing these donation rates. Existing studies on this subject mainly focus on the effect of different legislative systems on donation rates (For example; Gimbel, 2003; Abadie and Gay, 2006; Neto, 2007; Healy, 2005; Johnson and Goldstein, 2003). Two of those systems exist; presumed consent policy and the informed consent system. A presumed consent system implies inhabitants of a country should opt-out if they do not want their organs to be used for donation purposes after their death. If they do not opt-out, they are considered to have permitted they want to be donors. In countries applying an informed consent system, people are expected to opt-in if they do want to be a donor. In daily practice, differences between the systems are faded as in both systems family consent is often a condition for extracting organs (Cameron and Forsythe, 2001). These between country comparisons try to study the effect of presumed consent law on donation rates and correct for other variables, such as GDP, predominant religion in a country, the number of traffic deaths and health expenditure. Countries with a presumed consent system often do show significantly higher donation rates than countries using an informed consent system to register donors. In this thesis the goal is to study a broader range of determinants and to check their influence on donation rates. In the studies mentioned before that study the effect of presumed consent law, just a few factors are studied in isolation. In this thesis, the factors taken account for in other studies are studied jointly and some new factors, such as population density and acute care beds, are included in the analysis. The main question of this thesis therefore is: what are the determinants of organ donation? Using ordinary least squares regression method, the analysis shows that GDP, the number of traffic deaths, religion, population density and acute care beds have the strongest effect on a country’s donation rates. Also, confirming other studies, countries with presumed consent systems have significantly higher donation rates (Gimbel, 2003; Abadie and Gay, 2006; Neto, 2007). After this introduction, the organ shortage problem will be stressed in chapter two. In chapter three, an overview will be presented on articles studying which variables might influence donation rates. In paragraph 3.5, the so called ‘Spanish Model’ will be explained. In chapter four, a multiple regression will be performed, using independent variables discussed in chapter three together. Also, limitations of this analysis will be discussed. Chapter five concludes. https://thesis.eur.nl/pub/7866/ Fri, 20 Aug 2010 00:00:01 GMT <div>Durnek, V.</div> SUMMARY This thesis examines the economic and statistical sensitivity to alternative instruments for capital input in the measurement of hospitals’ cost efficiency. Efficiency is measured through a variable cost function. Capital is treated as the fixed input and measured in three alternative ways. The empirical analysis utilizes the longitudinal data on Dutch general hospitals. The three instruments for the quantity of capital are: the number of beds, the hospital’s floor space and the estimated nominal undepreciated capital stock. The results show that the statistical properties of the cost function are in favor of the nominal undepreciated capital stock, mainly because of the significance of its coefficient. Moreover, its monetary nature constitutes the most precise depiction of capital stock. Estimated mean sector efficiency is very similar between the cost function utilizing the nominal undepreciated capital stock and the number of beds. Their close association is, however, contradicted by the inconsistent rank‐order correlation. The floor space is assessed as the less reliable proxy especially due to its weak link to the hospital’s total capital stock. These findings indicate relatively high sensitivity of the efficiency outcomes to the definition of capital. As a supplement to this analysis an alternative model is developed and presented in the thesis. This model addresses the issue of endogeneity of capital in Dutch hospital sector and thus better reflects the utilization of capital. https://thesis.eur.nl/pub/7944/ Wed, 01 Sep 2010 00:00:01 GMT <div>Floor, M.</div> Op de wereld en binnen Nederland bestaan er grote verschillen op het gebied van inkomen. Tijdens mijn economiestudie is dit onderwerp mij steeds meer gaan interesseren. De grote verschillen op het gebied van inkomen, brengt vervolgens andere verschillen met zich mee. Één van die diversiteiten is te vinden binnen de mate van gezondheid van personen. Door deze beide diversiteiten samen te voegen en te zoeken naar een oorzaak hiervoor, ben ik gekomen tot deze scriptie. Het boeit me hoe de wereld financieel in elkaar zit, nog meer boeit de combinatie van economie en gezondheid me. In deze scriptie ben ik meer te weten gekomen over de verbanden tussen inkomen en gezondheid, die ik zal beschrijven. https://thesis.eur.nl/pub/8007/ Mon, 13 Sep 2010 00:00:01 GMT <div>Naaktgeboren, G.</div> Abstract In deze scriptie wordt onderzocht welke invloed baaneigenschappen hebben op de gezondheid zoals mensen die zelf ervaren. Om te onderzoeken of er een correlatie is tussen gezondheid en baaneigenschappen, zal er gebruik worden gemaakt van een regressieanalyse. Omdat algemene gezondheid afhankelijk is van meerdere factoren, zullen ook leefstijl en opleidingsniveau worden meegenomen in dit onderzoek. https://thesis.eur.nl/pub/8118/ Fri, 17 Sep 2010 00:00:01 GMT <div>Heun, J.</div> Since infectious diseases in developing countries continue to be widespread they are a cause of both health problems and mortality. Controlling them should be the first step in improving health, but how to effectively do this remains unclear. If income is the cause of health gains, then policies should target growth. But if income is not the cause then deliberate action aimed at health improvements should be the focus of policies. We find that that the arguments for income as the cause of health are weak and we find no relationship between inequality and health differences between countries. When testing the impact of key social services like education, sanitation and water we find a very weak relationship. But that can easily be explained by interaction mechanism. The case study of Costa Rica shows that the structural changes made in its health care system are an important factor in explaining health gains. These changes were mainly targeted at the ability of the health care system to provide good quality care for all, which included actively reaching out to the underprivileged sections of society. We conclude that income inequality is not a cause of poor health but health care inequality is. Political determination played an important role in the structural changes made and it is doubtful that these changes could have been made without the consistent long term political determination. We can conclude that deliberate actions does cause health gains but requires significant political power. https://thesis.eur.nl/pub/9036/ Tue, 15 Mar 2011 00:00:01 GMT <div>Ensink, W.</div> Samenvatting In deze scriptie worden de resultaten weergegeven van een empirisch onderzoek naar het effect van een jaar extra educatie op de beroepskeuze die mensen maken. Aanleiding voor dit onderzoek is eerder onderzoek waaruit blijkt dat er een verband is tussen educatie en gezondheid en tussen het type arbeid en gezondheid. Door dit onderzoek wordt gekeken of door educatie het type arbeid dat men verricht verandert, en via deze weg de gezondheid van mensen zou kunnen beïnvloeden. Voor dit onderzoek wordt gebruik gemaakt van een dataset uit Groot Brittannië, welke verkregen is in 1995. De relevante variabelen zijn het aantal jaren educatie en de sociale klasse, welke een maat is voor het type werk dat met verricht. De methodes waarvan gebruik gemaakt wordt zijn regressieanalyse en Regression Discontinuity Design. Hoewel bij de regressieanalyse geconstateerd wordt dat een jaar educatie significant leidt tot andere beroepskeuzes, is er ook gebruik gemaakt van Regression Discontinuity Design. Bij deze laatste methode wordt gekeken of het gevonden verband ook daadwerkelijk een causaal verband betreft. De eindconclusie van dit onderzoek is dat er geen causaal verband is tussen educatie en type arbeid. https://thesis.eur.nl/pub/9050/ Thu, 24 Mar 2011 00:00:01 GMT <div>Krzewina, T.</div> There is a strong body of research that indicates an association between domestic violence and poor health outcomes. The range of risks related to domestic violence is very long starting from decreased general well being to increased mortality. Most of the research was produced in the last 30 years and there are still extensive gaps in the available literature. There are almost no longitudinal studies and most of the research focuses on the developed countries. This paper is based on a representative sample of 816 respondents and attempts to disclose the real impact of domestic violence on health care need and utilisation in Curacao. Its main goal is to stress the importance of the issue as a public policy concern. It reveals the scale of domestic violence prevalence and shows a strong association between different forms of abuse and negative healthcare outcomes. https://thesis.eur.nl/pub/9138/ Thu, 12 May 2011 00:00:01 GMT <div>Langenhoff, W.</div> Employee absenteeism is a worldwide phenomenon which, due to the financial impact on a nation‟s economy, is an important subject on the international agenda. In order to provide new insights into employee absenteeism a model with a broad variety of determinants is constructed and tested for Europe as a whole and the individual countries. Based on previous studies, a wide selection of determinants was distinguished and divided into categories such as demographics, health-, household- and job characteristics. With the country comparison the designed model tested whether it also holds explanatory value for individual countries and whether differences existed in absence behaviour due to country characteristics. A dataset from the European Community Household Panel (ECHP) was used to test the model. This survey provided the necessary information and is constructed as such that it can be used for international comparisons. The designed model is based upon the effects of latent variables and because of the binary aspect of the dependent variable a probit analysis is conducted. The outcome of the marginal effects method of the probit model provides evidence that the pooled model has a high degree of explanatory power. Although not all determinants showed the expected results, strong significance was found for the constructed model as a whole and the individual determinants. Regarding the test results for the individual European countries, ambiguous results were found. These differences originate from different country characteristics and hence, the model should be adjusted for the individual countries. https://thesis.eur.nl/pub/9400/ Tue, 05 Jul 2011 00:00:01 GMT <div>Pater, L. de</div> The impact of occupation on health is getting growing interest in the field of Health Economics. Occupation is one factor of socioeconomic status, which may influence health. Other socioeconomic characteristic which do have an impact on health are education and income. The number of years of education and higher income do have a positive impact on health. Occupation is also discussed as a social determinant of health, although it has received little attention in economic research. The thesis studies the impact of manual occupation health, compared to non-manual occupation in the United Kingdom. The data set consist of 3,347 observations from The British Household Panel Study (BHPS). The panel study makes it possible to examine health deterioration over the period 1991 and 2009. An ordinal logistic regression is used to study the impact of manual occupation on health, controlling for initial health and several socioeconomic characteristics as education and income. The results suggest that manual occupation has a significant negative impact on health. https://thesis.eur.nl/pub/9574/ Wed, 20 Jul 2011 00:00:01 GMT <div>Kronenberg, W.</div> Abstract This paper replicates an earlier study to confirm whether or not health status plays a causal role in portfolio decision using data from the DNB Household Survey. Most previous studies found positive and significant relationships between health and portfolio choice. This paper belongs to the minority which is not able to establish such a causal link, despite running multiple models over a 15year time range and the inclusion of psychological factors such as risk and time preferences. Nonetheless during the research doubt was raised with respect to the methodologies used in the past literature, maybe explaining their significant outcomes. https://thesis.eur.nl/pub/9668/ Sun, 31 Jul 2011 00:00:01 GMT <div>Andersone, L.</div> The necessity to refocus health policy from health care services to a broader base of determinants of population health which lie outside health care system is already recognised (Deaton, 2002) and therefore conclusive evidence on determinants of health outside health care system and their magnitude is essential. Although the strong associations between more education and lower mortality had given ground to argue for education policy as a part of health policy (Gwatkin, 1982) it was not enough to justify economic and political decisions. Conclusive evidence on causal effect in the education-health association would provide certainty and help to make better decisions on resource allocation towards health services or education since it is already recognised that determinants of health also lie outside the health sector (Deaton, 2002). Although education is a strong correlate of health regardless of choice of proxy for health (Van Kippersluis et al., 2009, Oreopoulos, 2003, Elo and Preston, 1996), determining causal effect has been and still remains a challenge due to the problems tackling the reverse causality. On the one hand education attainment could determine individual’s health, on the other it could very well be that individual’s health in childhood could determine educational attainment. A third alternative suggests that the relationship between the two is determined by other factors to which both are associated. Identification of a causal pathway or lack of it between education and health has societal importance because knowledge of a determinant, the direction and magnitude of its effect is a powerful tool to improve policy decisions. Along with enhanced capacity to make future policies, an understanding of the causal mechanism allows a more precise and comprehensive evaluation of the effects of current and past education and health policies. Currently the empirical evidence is mixed and therefore inconclusive. There are studies which suggest that health determines educational attainment by reporting that bad poor childhood health and low birtweight has negative effect on schooling later on (Behrman and Rosenzweig, 2004, Case et al., 2005), but findings are challenged by Cutler and Lleras-Muney (2006). There is also a growing body of evidence which supports the causal pathway from education on health (Grossman, 2004, Cutler and Lleras-Muney, 2006). A recent trend in the literature is drawing evidence from analysis of schooling reforms in the U.S. (Lleras-Muney, 2002, Adams, 2002), Denmark (Arendt, 2005, 2008), Sweden (Spasojevic, 2003), the Netherlands (Van Kippersluis et al., 2009), and the U.K. (Silles, 2009, Clark and Royer, 2008). Although the results from schooling reforms are believed to be source of strong evidence (Grossman, 2004), there is variation in the results. While Silles (2009) reports a significant positive effect from the reform to schooling in the UK, Clark and Royer (2008) fail to find a causal effect on health from the same reform. There is also mixed evidence regarding the mechanisms through which education may influence health production. Studies of Grossman (2006) and Kenkel (1990) report evidence that supports the allocative efficiency hypothesis while Cutler and Lleras-Muney, 2006 point towards allocative efficiency hypothesis. The purpose of this study is to investigate whether education has an effect on health behaviours. According to the allocative efficiency in health production hypothesis (Grossman 2006) the more educated alter their behaviour in a way which results in better health. This paper firstly attempts to replicate Silles (2009) findings on the effect of schooling reform on self-reported health using the UK General Household Survey data to infer causal pathway from education to health. Secondly it adds to the current literature in the field by further exploring whether similar patterns exist in health-related behaviours: smoking, drinking, and physical activities. Finding similar disparities in health behaviours would confirm the allocative efficiency hypothesis whereas lack of it would give more plausibility to production efficiency models and therefore would contribute to the existing research in the causal effect mechanisms. While Clark and Royer (2008) explore smoking and body mass index behaviour patterns by education, according to author’s knowledge, drinking and exercise behaviours have not been previously examined in the UK population. Currently most of the studies use instrumental variables (IV) method to solve the endogeneity problem with education and health implied by their reverse causality (Adams, 2002, Arendt, 2005, Spasojevic, 2010, Grossman, 2006). The study also contributes to the existing empirical evidence by applying the method of regression discontinuity design (RDD) which has gained popularity recently and is said to be (Lee and Lemieux, 2009) and is used not only as a complement to IV (Silles, 2009), but lately also as the main method of research (Clark and Royer, 2008) to study health and education relationship. The advantages of RDD include high internal validity and being a very close substitute for a randomised trial and the design is very appropriate for researching natural experiments like education reforms (Lee and Lemieux, 2009). The disadvantage of this method yielding only a very local treatment effect is overcome by the fact that the local treatment effect is the primary interest in this study. The results reported show that no effect of the education reform on the general health of individuals is found although correlations between health and education are consistent with current empirical evidence. An increase in likelihood in reporting a long-standing illness is found, but it is not retain significance in sensitivity analysis. None but two health behaviours are affected by the reform: quitting smoking and on preferring high tar level cigarettes. The likelihood of quitting smoking increased while probability of preferring high level tar cigarettes among smokers decreased substantially. The results of the impact on smoking behaviours do suggest that education could an effective tool for smoking cessation policies and strategies. The magnitude of the effect, however, is sensitive to bandwidth specification and therefore conclusive evidence cannot be drawn. It is likely that having data from more and younger individuals at interview may be a complementary factor to the sensitivity to bandwidth which are driving the differences between this study and those of Silles (2009) and Clark and Royer (2008). Future research using earlier waves of the General Household Survey data could however add more certainty on whether the lack of significant effect is due to no causal pathway from the reform or the effect is mitigated by self-selection as individuals age. This research could also add more robust evidence of the changes in smoking behaviours. This study is organised in five chapters where the in the first one the background, current theoretical frameworks and empirical evidence along with methodology and the background of the 1944 Education Act reform is included. Data used in the study is described in chapter two and the results are reported in chapter three. They are followed by discussion of the results found in health outcome and health behaviours in chapter four and the conclusions of the study are presented in chapter five. https://thesis.eur.nl/pub/9725/ Mon, 08 Aug 2011 00:00:01 GMT <div>Zheng, Xue</div> Introduction An economic evaluation provides information to investigate whether an intervention is a good use of society's resources; it assists policy makers to make an optimal decision for different interventions in various settings. Lifestyle and drug intervention are often implemented for primary preventive purposes in many diseases, among other cardiovascular diseases. Based on the Dutch guideline for cardiovascular risk management, in primary prevention, physical activity and diet as lifestyle intervention and statins as drug intervention are advised for people with low to moderate high CVD risks. Studies have shown favourable outcomes in the cost effectiveness of these two interventions. However, based on the nature of these two interventions, it is interesting to have more insight on how these economic evaluations are conducted and observe if differences exist between studies on lifestyle and drug interventions. The purpose of this systematic review is to assess potential disparities in the methodology between the cost-effectiveness studies on drug treatment (i.e. statins) and lifestyle interventions (i.e. a combination of physical activity and diet advice) for primary prevention of cardiovascular diseases. Further, this study is also interested in potential relationships between different factors (e.g. time horizon, funding source, incremental cost-effectiveness ratios and etc.) and to what extent these associations hold for these two interventions https://thesis.eur.nl/pub/9810/ Tue, 16 Aug 2011 00:00:01 GMT <div>Noordhof,, E.</div> n deze scriptie wordt onderzoek gedaan naar het verband tussen sociaal-economische variabelen en de mate van gezondheid. Deze sociaal-economische variabelen zijn inkomen, opleiding en werkloosheid. Door middel van meerdere analyses zal het verband worden onderzocht tussen deze variabelen en het gezondheidsniveau van de respondenten uit de gebruikte dataset. Aanleiding voor dit onderzoek zijn eerdere studies uit Nederland en de Verenigde Staten die hebben aangetoond dat er een verband bestaat tussen inkomen, opleiding, vermogen en gezondheid. De vraag blijft welke variabelen van invloed zijn op gezondheid, of dat de causaliteit wellicht andersom bestaat. Voor dit onderzoek wordt gebruik gemaakt van de GSOEP, een dataset uit Duitsland. Specifiek de resultaten uit het jaar 2008 zijn voor de analyses van dit onderzoek gebruikt. De resultaten van de analyses zullen worden vergeleken met de resultaten van een onderzoek met Nederlandse data. De conclusie van dit onderzoek is dat mensen met een lage sociaal-economische status vaker een slechte gezondheid rapporteren dan mensen met een hoge sociaal-economische status. Er is een duidelijk verband dat mensen zonder werk of met een lage opleiding of een laag inkomen, vaak ongezonder zijn dan mensen die wel werk, een hoge opleiding of een hoog inkomen hebben. Het is aannemelijk dat de hoogte van de opleiding direct invloed heeft op gezondheid. De richting van causaliteit tussen inkomen, werkloosheid en gezondheid is echter niet duidelijk aantoonbaar. https://thesis.eur.nl/pub/9909/ Thu, 25 Aug 2011 00:00:01 GMT <div>Dingemans, K.</div>