Background: Generally, a significant portion of healthcare spending consists of out-of-pocket (OOP) expenses. Patients indicate that, in practice, there are often some OOP expenses, incurred when they receive medical care, which are unexpected for them and should have been taken into account when deciding on a course of action. Patients are often reliant on their GP and may, therefore, expect their GP to provide them with information about the costs of treatment options, taking into consideration their individual insurance plan. This also applies to the Netherlands, where OOP expenses increased rapidly over the years. In the current study, we observed the degree to which matters around patients' insurance and OOP expenses are discussed in the Netherlands, using video recordings of consultations between patients and GPs. Methods: Video recordings were collected from patient-GP consultations in 2015-2016. In 2015, 20 GPs and 392 patients from the eastern part of the Netherlands participated. In 2016, another eight GPs and 102 patients participated, spread throughout the Netherlands. The consultations were coded by three observers using an observation protocol. We achieved an almost perfect inter-rater agreement (Kappa = .82). Results: In total, 475 consultations were analysed. In 9.5% of all the consultations, issues concerning patients' health insurance and OOP expenses were discussed. The reimbursement of the cost of medication was discussed most often and patients' current insurance and co-payments least often. In some consultations, the GP brought up the subject, while in others, the patient initiated the discussion. Conclusions: While GPs may often be in the position to provide patients with information about treatment alternatives, few patients discuss the financial effects of their referral or prescription with their GP. This result complies with existing literature. Policy makers, GPs and insurers should think about how GPs and patients can be facilitated when considering the OOP expenses of treatment. There are several factors why this study, analysing video recordings of routine GP consultations in the Netherlands, is particularly relevant: Dutch GPs play a gatekeeper function; OOP expenses have increased relatively swiftly; and patients have both the right to decide on their treatment, and to choose a provider.
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This study analyses the determinants of cycling expenditure by means of a Tobit regression analysis, based on a dataset of 5,157 cyclists. Using a heterodox economic framework, 23 different variables are combined into two commonly used variable groups (socio-demographics, sports intensity variables) and two rarely investigated variables groups (socio-economic cycling capital, psychographics). With all variables included in the Tobit regression, gender, trip duration, frequency, number of cycling variants practiced, visiting cycling websites, and practicing road-cycling or mountain bike are positive determinants of cycling expenditure. A negative association is found with competitive riding and cycling drop out. Marketeers of cycling services and cycling apparel should meet the cyclists need for identification instead of focusing solely on socio-demographic factors.
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Aim: Aim of this study was to provide insight into the costs associated with severe mental illnesses from a societal perspective. Insight into expenses is of value to policymakers and mental health institutions that are dealing with ongoing budget cuts. A reliable cost estimate is also necessary to assess the cost-effectiveness of interventions and make decisions on reimbursement. Methods: Baseline costs were calculated for 188 individuals with severe mental illness (SMI) who wish to increase their societal participation defined as paid or unpaid work, education and meaningful daily activities. Costs were measured from a societal perspective by means of the TIC-P questionnaire and expressed in Euros.
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At ageing, there comes a certain point when people are no longer able to live independently in their own homes. With an ever increasing elderly population, this constitutes a significant and increasing burden for the health care expenses. The need for more cost effective solutions is evident.Research from H. van der Kloet (Hanze UAS) suggests that there is one main concern why people consider moving to an elderly home earlier than they actually need to; safety. There are many aspects to safety: self reliance, self confidence, indoor security and social security.With the elderly population becoming more technically aware, the opportunity of using technology to enable a longer independent life while maintaining or even enhancing quality of life, and thus to prevent rising health care expenses, is possible.With this in mind a Home Automated Living Platform (H.A.L.P.) was developed.
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Background: To facilitate adherence to adaptive pain management behaviors after interdisciplinary multimodal pain treatment, we developed a mobile health app (AGRIPPA app) that contains two behavior regulation strategies. Objective: The aims of this project are (1) to test the effectiveness of the AGRIPPA app on pain disability; (2) to determine the cost-effectiveness; and (3) to explore the levels of engagement and usability of app users. Methods: We will perform a multicenter randomized controlled trial with two parallel groups. Within the 12-month inclusion period, we plan to recruit 158 adult patients with chronic pain during the initial stage of their interdisciplinary treatment program in one of the 6 participating centers. Participants will be randomly assigned to the standard treatment condition or to the enhanced treatment condition in which they will receive the AGRIPPA app. Patients will be monitored from the start of the treatment program until 12 months posttreatment. In our primary analysis, we will evaluate the difference over time of pain-related disability between the two conditions. Other outcome measures will include health-related quality of life, illness perceptions, pain self-efficacy, app system usage data, productivity loss, and health care expenses. Results: The study was approved by the local Medical Research Ethics Committee in October 2019. As of March 20, 2020, we have recruited 88 patients. Conclusions: This study will be the first step in systematically evaluating the effectiveness and efficiency of the AGRIPPA app. After 3 years of development and feasibility testing, this formal evaluation will help determine to what extent the app will influence the maintenance of treatment gains over time. The outcomes of this trial will guide future decisions regarding uptake in clinical practice.
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This applied research is an attempt to analyse the effectiveness of milk marketing and facilitate developing a sustainable milk value chain for dairy farmer’s groups in Punakha district. Both quantitative and qualitative methods of survey, key informant interviews and focus group discussion were used as research strategies to obtain relevant information. The survey was conducted using both open and closed-ended structured questionnaire in seven subdistricts of Barp, Dzomi, Guma, Kabisa, Shelnga-Bjemi, Talog and Toedwang. A total of 60 respondents; 30 existing milk suppliers and 30 non-milk suppliers were drawn using a simple random sampling technique. One-to-one interviews were conducted following semi-structured questions with eight key informants in the chain. One focus group interview was conducted with the existing dairy farmer groups representatives to triangulate and discover in-depth information about the situation of the milk value chain in the district. The survey data was analysed using the Statistical Package for Social Sciences software version 20. A method of grounded theory design was used to analyse the qualitative data of interviews and focus group discussion. Value chain mapping was employed for assessing the operational situation of the current milk chain. The mean cost of milk production was estimated at Nu.27.53 per litre and the maximum expenses were incurred in animal feeds which were estimated to be 46.34% of the total cost of milk production. In this study, milk producers had the highest share of added value and profit which were estimated at 45.45% and 44.85% respectively. Limited information and coordination amongst stakeholders have contributed to slow progression in the formal milk market. The finding reveals that 90% of nondairy farmer groups respondents were interested in joining formal milk marketing. The average morning milk available for supply from this group would be 4.41 ± 3.07 litres daily by each household. The study also found that 50% of the respondents were interested in supplying evening milk with an average of 4.43 ± 2.25 litres per day per household. Based on the result of this study, it was concluded that there are possibilities of expanding the milk value chain in the district. However, there is a need to enhance consistent milk supply through a quality-based milk payment system, access to reasonable input supplies, and facilitate strong multi-stakeholder processes along the milk value chain.
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This video provides small and medium enterprises (SMEs) with a concise breakdown of the costs involved in initiating a data science project. It categorizes expenses into three primary areas: personnel, infrastructure, and data-related costs. Through a practical example of a marketing agency’s venture into customer segmentation, viewers get a tangible sense of potential expenditures. Emphasizing the importance of clear project goals and efficient resource allocation, the session offers insights into making cost-effective decisions in data science endeavors.
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In today’s world, digital transformation enhancement in IT sector becomes crucial for efficient solutions in organizations. Institutions in public sector try to enrich its process solutions with additional products and services. On the other hand, especially in developing countries, there is a high tendency to obtain products with domestic resources in order to reduce financial expenses. Besides, it may be crucial for public and military institutions to develop IT products with domestic resources in order to preserve data security and privacy. Thus, there is a need to develop a reliable scale to measure nationality and domesticity of products. This study attempts to construct a methodology for determining country of origin of IT products. Suggested methodology was verified by interviews with experts in subject area.
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In this chapter the autor explores the contours and possible effects of the WMO for the local government level. First she gives a short overview of the main features of the WMO (PAR. 2.5). Then she describes the challenges that local government is confronted with, especially the political decisions that have to be taken at the local level (PAR. 2.3). The question to be answered is whether or not the WMO means an impulse for local democracy in the Netherlands. To that purpose, two quick comparisons are made (PAR. 2.4): with other decentralisation operations in the Netherlands, and with the decentralisation of social care and welfare in Sweden. These comparisons make it possible to determine two main conditions for creating an impulse for local politics, which are presented in PAR. 2.5. The article ends by some concluding remarks on the effect of the WMO on the local democracy in the Netherlands.
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