Zoekresultaat: 6 artikelen

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Van transitie naar transformatie van de jeugdhulp

Biedt de transactiekostentheorie aanknopingspunten voor meer kwaliteit, minder uitvoeringskosten en lagere administratieve lasten?

Tijdschrift Bestuurs­wetenschappen, Aflevering 2 2019
Auteurs Drs. Nanko Boerma en Dr. Bert Bröcking
SamenvattingAuteursinformatie

    In the implementation of the Dutch Youth Act, since the so-called ‘transition’ of 2015 under the responsibility of the municipalities, there are three major problems: the municipalities are short of money, the implementation of youth aid is accompanied by high administrative burdens and there are serious quality concerns, especially where different care providers must work together for one client. This article deals with the possibilities of the economic transaction cost theory for realizing improvements through organizing more effective collaboration between municipalities and healthcare providers. Transactions are a ‘forgotten’ cost source. There are three sources of transaction costs: limited rationality, opportunistic behavior and ‘asset specificity.’ In this article the authors analyze twelve problems documented in the literature on youth care from this perspective. This creates a framework from which municipalities can tackle these problems in order to improve the quality of youth care, to keep costs under control and to reduce the administrative burden. In a number of sectors and large projects ‘linking zones’ appear to be a way to increase the trust between players in a chain, so that transaction costs fall. Where poor cooperation between chain partners in youth care is a major cause of the problems, municipalities can make significant gains by establishing linking zones with care providers contracted by them. This article outlines the method in a linking zone.


Drs. Nanko Boerma
Drs. N. Boerma is van huis uit politicoloog en is voorzitter/directeur van de stichting Transactieland, het kennisinstituut voor transactie-innovatie.

Dr. Bert Bröcking
Dr. B.C. Bröcking is adviseur op het terrein van de jeugdhulp. Hij schreef over de rollen van cliënt, hulpverlener en overheid in de jeugdhulp.
Artikel

Herstel en vertrouwen: professionals, ervaringswerkers en de herstelvisie in de Nederlandse geestelijke gezondheidszorg

Tijdschrift Beleid en Maatschappij, Aflevering 3 2018
Trefwoorden Trust, Recovery, Professionals, Peer specialists, Habermas
Auteurs Marijn Kester MSc en Mr. dr. Olivier Lingbeek
SamenvattingAuteursinformatie

    This text wants to draw attention to the question: How do peer specialists build a bridge between the modus operandi of health care professionals and the lifeworld problems of clients receiving mental health care? The Dutch mental healthcare system has recently been host to a range of new developments. Two new trends can be distinguished, going by the name of ‘Recovery-oriented healthcare’ and the introduction of ‘Peer Specialists’. These coincide with changes in budget and organization of treatment. There is an increased awareness of the need for efficiency and cost reduction in the organization of care. The meaning and use of recovery-centered approaches and working with peer specialists remain fairly marginal enterprises due to ever increasing pressure emanating from execution of regulations and administrative procedures, and an accompanying decrease of professional autonomy. In the light of Habermas’ theoretical framework, it is an emphasis on a system-oriented organization of care that cause new approaches to barely be able to find a considerable place in the contemporary practice of mental healthcare in the Netherlands. Trust is identified as an essential foundation on the basis of which future principles of organization should be developed.


Marijn Kester MSc
Marijn Kester MSc is medisch socioloog.

Mr. dr. Olivier Lingbeek
Mr. dr. Olivier Lingbeek heeft een eigen adviesbureau op het gebied van bestuurlijke vraagstukken met betrekking tot planologie en sociologie.
Casus

Access_open In de zorg voelt de winst van de een nu als het verlies van de ander

Naar een beter begrip van winst in de zorg door in de discussie over winst in de zorg onderscheid te maken tussen een leefwereld- en een systeemwereldperspectief

Tijdschrift Beleid en Maatschappij, Aflevering 1 2018
Trefwoorden Profit, healthcare providers, health insurers, lifeworld perspective, system perspective
Auteurs Drs. Piet de Bekker en Dr. Eric van der Hijden
SamenvattingAuteursinformatie

    In this feature authors discuss recent research findings that are of interest to readers of Beleid en Maatschappij.
    Systematic research on societal responses to profit in healthcare is scarce. It is a highly complex topic, with many tensions in the public and political debate. In a recent Dutch publication on profit, authors use a ‘lifeworld’ perspective to assess profit in their research, while their assessment could have been different using a ‘system’ perspective. Both perspectives have their merit, and debate on the role of profit in health care should separate the two perspectives. We describe both perspectives and use them to clarify whether making a profit is different from paying that profit to shareholders. We conclude that in healthcare, the general tension between the perspectives can be summarized as ‘profit for one actor may feel – but isn’t always – someone else’s loss’. Recognizing these tensions and searching for a strategy to align interests in which everyone gains may help the current stagnated debate on this issue in the Netherlands.


Drs. Piet de Bekker
Drs. Piet de Bekker is PhD-onderzoeker aan de Vrije Universiteit Amsterdam, Talma Instituut, sectie Gezondheidseconomie. Hij is tevens partner en adviseur bij Zorgvuldig Advies.

Dr. Eric van der Hijden
Dr. Eric van der Hijden is teamleider Gepaste Zorg aan de Vrije Universiteit Amsterdam, Talma Instituut, sectie Gezondheidseconomie. Hij is tevens beleidsadviseur zorginkoop bij Zilveren Kruis Zorgverzekeringen.
Artikel

Waarom zorgorganisaties in Nederland fuseren

Tijdschrift Bestuurskunde, Aflevering 3 2016
Trefwoorden merger motives, healthcare executives, health policy, healthcare reform, healthcare mergers
Auteurs Dr. Jeroen Postma en Anne-Fleur Roos MSc.
Samenvatting

    In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in our knowledge by analyzing the results of a survey study among Dutch executives about mergers between healthcare organizations in the period from 2005 to 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increased competition, more pressure from purchasers (health insurers), growing financial risks, de-institutionalization of long-term care and decentralization of healthcare services to municipalities. Our study shows that Dutch healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Efficiency and financial reasons are also important drivers of merger activity in healthcare. Motives for mergers seem to be related to changes in health policy, in particular to the increasing pressure from competitors, insurers and municipalities.


Dr. Jeroen Postma

Anne-Fleur Roos MSc.
Artikel

Gezocht: Burgerparticipatie (voor vaste relatie)

Een vergelijkende gevalsstudie naar 26 lokale netwerken in het sociale domein in de regio Arnhem

Tijdschrift Bestuurskunde, Aflevering 1 2016
Trefwoorden citizen participation, co-production, local networks, decentralization, collaboration
Auteurs Rigtje Passchier MSc en Dr. Jelmer Schalk
SamenvattingAuteursinformatie

    In 2015, Dutch local governments have become responsible for youth care, social welfare, employment and income assistance programs, as a result of decentralization. Many municipalities have set up service delivery networks and community teams, in which they collaborate with healthcare providers and civic organizations to build integrated care services. It is assumed that these networks will improve outcomes in terms of enhanced people’s self-reliance and healthcare cost control; by operating close to citizens they are in a position to know the client, activate a client’s social network and mobilize specialized professional expertise if necessary. However, a comparative case study of 26 emerging local networks in the Arnhem area indicates that healthcare providers use the networks mainly for presentation purposes in an effort to secure business continuity, that the role of local governments is fuzzy, and that citizen participation only thrives when actively encouraged in a climate of trust.


Rigtje Passchier MSc
R. Passchier MSc is interim manager voor de publieke zaak en promovenda aan de Universiteit Leiden.

Dr. Jelmer Schalk
Dr. J. Schalk is universitair docent aan de Universiteit Leiden.
Artikel

Sluipend kwaliteitsverlies in de geestelijke gezondheidszorg

Professionals over de gevolgen van marktwerking

Tijdschrift Beleid en Maatschappij, Aflevering 1 2011
Trefwoorden mental health care, marketization, Diagnosis Related Groups (DRG’s), policy implementation, professionalism
Auteurs Nienke van Sambeek, Evelien Tonkens en Christian Bröer
SamenvattingAuteursinformatie

    In order to facilitate the creation of a regulated market, Diagnostic Treatment Combinations (DBC’s in Dutch) have been introduced in Dutch mental health care in 2008. DBC’s are developed to distinguish and price the ‘products’ of health care, in order to make comparison and competition between health care providers possible. In this qualitative study we analyzed mental health care professionals experiences with the DBC-system. We focused on two questions: (1) what does the DBC-system and the related introduction of marketization of mental health care mean for professionals? and (2) how do professionals cope with the DBC-system in their daily practices? We found that the logics of the market and bureaucracy, both incorporated in the DBC-system, often conflicted with the values and ethics of mental health care professionals. Mental health professionals experience deterioration of professionalism and quality of care. They were coping with conflicting values by non-compliance with rules and pragmatic use of the DBC-system. It is argued that the efforts of professionals to protect the quality of their work might actually lead to invisibility of the problems they encounter, which reinforces the policy they criticize.


Nienke van Sambeek
Nienke van Sambeek is psycholoog bij de Psychologische Praktijk Putten.

Evelien Tonkens
Evelien Tonkens is bijzonder hoogleraar actief burgerschap, afdeling Sociologie en Antropologie aan de Universiteit van Amsterdam en toezichthouder GGZ centraal. Correspondentiegegevens: prof. dr. Evelien Tonkens, Universiteit van Amsterdam, afdeling Sociologie en Antropologie, St. Actief burgerschap, Oudezijds Achterburgwal 185, 1012 DK Amsterdam, E.H.Tonkens@uva.nl.

Christian Bröer
Christian Bröer is universitair docent sociologie aan de Universiteit van Amsterdam.
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