https://thesis.eur.nl/org/5005/ List of Publications en https://thesis.eur.nl/pub/41568/ Fri, 11 Aug 2017 00:00:01 GMT <div>Ponsen, C. (Christian)</div> https://thesis.eur.nl/pub/43843/ Sun, 17 Jun 2018 00:00:01 GMT <div>Sande, J.F.L. van de (Jolien)</div> Nowadays, people aged over 65 are healthier and more socially active than their parents and grandparents used to be in that life stage. This group of elderly demands comfortable, safe and affordable houses, appropriate to live independently at home for a longer period of time. Government policies are also directed towards ageing in place. However, partially due to the ageing of the population, there is a shortage of suitable houses for this group. Living communities might be a suitable solution for these people. However, not all elderly are financially eligible for living in a community. Therefore, the accessibility of living communities in The Hague for elderly people with different characteristics is discussed in this report. Furthermore, it is examined how various actors deal with accessibility requirements. These characteristics are assessed by the theoretical concept of capital. Capital consists of certain resources that people have acquired through effort during their lives. Those resources can be deployed for a certain purpose. The found types of capital are: economic capital, such as equity and income; cultural capital, in the form of acquired skills through educational background and professional experience, and social capital, in the form of people’s social network. Also, personal capital as in physical and mental health, personality and communicational skills came to the fore as an unexpected type of capital. Besides, the use of institutional work by actors to maintain, disrupt and create institutions such as accessibility requirements was analysed. The data was collected within two months. Interviews were conducted with community members and employees of housing corporations and the Centre for community living in The Hague. Also document analysis and observations were performed. For the coding of the data, abductive analysis was used. Community living turned out to be a pleasant possible form of housing for a wide range of elderly in The Hague. However, living communities are inaccessible for a large proportion of this group. Social, cultural and especially personal capital, appeared to be very useful sources of capital for interested people to possess. Those sources stimulate each other and are therefore concentrated within a small group. However those few people often possess too much economic capital, which appeared to be a necessary source that is often a barrier. For communities it is necessary to select members on their social, cultural and personal capital to remain dynamic and maintain their core identity. However, despite the fact that communities possess this powerful tool, their identity is threatened by problems related to ageing and income requirements. Nevertheless, board members and candidates have found creative ways to halt these threats. Nepotism, influencing economic capital and negotiations are all examples of disruptive institutional work that have occurred in various communities. Despite these efforts, community members or policymakers have not yet succeeded in conducting institutional work as creation. However, both policymakers and communities are working on solutions, such as creating communities with a mixture of houses for different incomes and ages. Also, trying to extent the margins within appropriate assignment might be a solution. Besides, policymakers and communities themselves should promote the concept of community living among the public and put it on the political agenda, to be able to solve the issues that communities are facing. Those ideas are hopeful possible solutions for the maintenance of community living in The Hague. If the described issues are solved, community living has the potential to become a widespread and successful form of ageing in place in the future. https://thesis.eur.nl/pub/43763/ Sun, 12 Aug 2018 00:00:01 GMT <div>Knaap, M.A. van der (Manouck)</div> In the Dutch health insurance market, collective insurances respond to risk factors of specific populations. A minimacontract is such a collective insurance focusing on people with low income and high healthcare costs, aiming to prevent indebtedness (Zorgwijzer, 2017b). This study is a first exploration of the effect of minimacontracts on the debt of defaulters and compares enrollees with non- enrollees. Due to minimacontracts varying in their composition, this study looks into four common elements, knowing: reinsurance of the deductible, municipality contribution, docket and income requirement for enrolment. This study used data from Dutch health insurer Achmea, consisting of 162.238 defaulters divided over 391 municipalities. The data has been analyzed based on the duration of indebtedness, with a focus on people indebted for 0-6 months, 7-12 months, 1-4 years, 4-8.5 years and 0-8.5 years. The OLS analysis shows that defaulters enrolled in minimacontracts have an overall lower basic insurance debt of 53€ and deductible debt of 179€ than non-enrollees (p<0.005). However, the supplemental insurance debt is found to be 224€ higher for enrollees (p<0.005). In all three insurance components the effect is found to increase overtime, holding that the longer a defaulter is indebted, the bigger the difference between enrollees and non-enrollees. Zooming in on the effects of the four elements of minimacontracts was done with the Spearman correlation test, with a selection of the dataset, composing 4.861 enrollees divided over 68 municipalities. First, reinsurance has been found effective with a lower debt in all three health insurance components. Only the effect in the basic- and supplemental insurance are found to be statistically significant (p<.0001). Second, a higher municipality contribution has a lowering effect on the basic- and supplemental insurance debt. The deductible debt is found to be higher. All results are found to be significant (p<0.02). Third, a higher income requirement for enrolment shows a higher debt for the basic insurance and supplemental insurance, but a lower debt difference for the deductible. All three results are found to be highly insignificant (p>0.1) and hence the element is found not to be effective. Fourth, enrollees using docket are found to have a lower basic- and deductible debt, but a higher supplemental insurance debt (p<.0001). Docket is found to be effective. Interpreting the results the following conclusions can be drawn: Minimacontracts are found to have a lowering effect on the median debt of defaulters, with reinsurance and docket as best practices. Although a higher contribution leads to a lower debt, it is not found to be an effective tool to prevent indebtedness. Next, income requirement is highly likely to affect the median debt of defaulters, but does not prevent indebtedness either. It can even disadvantage people who are as a consequence not eligible. Nevertheless, it is important to acknowledge that the role of minimacontracts is far from straightforward. Indebtedness can be a consequence of various life events and choices, not simply caused by (non) enrolment. If, based on the found effects, docket and reinsurance are widely implemented, it is expected that the median health insurance debt of defaulters decreases. The most important recommendations for health insurers, Dutch municipalities and government are the inclusion of docket and reinsurance in minimacontracts, enabling docket for income from labor and the redirection of care allowance to health insurers. https://thesis.eur.nl/pub/43379/ Sun, 12 Aug 2018 00:00:01 GMT <div>Vries, C.E. de (Christiaan)</div> As demand for healthcare continues to outstrip available public funding, healthcare rationing has become inevitable. Care rationing fundamentally is an ethical issue, which must respect moral principles to be publicly legitimate. In the face of a growing ‘rights culture’ within society, citizens are increasingly turning to the courts to claim care, invoking the right to health. Public law relating to healthcare rationing can prove valuable in achieving public legitimacy of allocative policy. Rationing in healthcare thus is in its core an ethical policy issue that could gain in legitimacy through public law adjudication. In this paper the underlying principles in ethics and European public law at the level of the UN, the Council of Europe and the EU on the subject of healthcare rationing are studied. Though much overlap between these principles exits, certain criteria for public legitimacy differ. As the judiciary serves an important role in providing the moral principle of accountability, the individual’s access to justice is assessed. It is concluded that this must be expanded for European citizens from what is currently possible. More countries must allow the individual complaints procedure under the ICESCR Optional Protocol through ratification and the ECSR must expands its complaints procedures to include an option for the individual citizen.