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Artikel

Optimale schaal en bereikbaarheid: Een spreidingsmodel voor ziekenhuiszorg in vlaanderen

Tijdschrift Bestuurskunde, Aflevering 4 2011
Trefwoorden optimal scale, accessibility, planning, hospitals, Flanders
Auteurs Jos Blank en Bart van Hulst
SamenvattingAuteursinformatie

    Social welfare has often been presented in the hospital research area in terms of travel costs and or distances. Most hospital cost studies only focus on the private costs generated by hospitals caring for patients. However, patient inputs in terms of patient travel cost and time cost are often neglected. In this article we combine both these factors, and optimize the social cost being the sum of the operating cost of hospitals and the costs of accessibility. This article presents a pure economic model for optimizing the social costs, the optimum gives us insight in the lowest hierarchical administrative level on which the provision of hospital care can be planned.

    The model is applied to the Flemish hospital sector for three types of products: revalidation, basic hospital care and radiotherapy. In this study, we point out that as the population (and patient base) increases, existing hospitals would have to expand moving further along the average cost curve into the region where decreasing returns to scale would prevail and by definition, higher cost. Building another hospital could both relieve the pressure on existing hospitals as well as decrease aggregate patient travel costs, i.e., social costs. By dividing the district into regions, we are able to establish the optimal number (and size) of hospitals. We found that the Flemish region should not be divided too much even though travel costs are minimized since the hospitals would be too large and too costly.


Jos Blank
Dr J.L.T. Blank en drs B.L. van Hulst zijn werkzaam bij IPSE Studies aan de TU Delft.

Bart van Hulst
Dr J.L.T. Blank en drs B.L. van Hulst zijn werkzaam bij IPSE Studies aan de TU Delft.
Artikel

Schalen in België

De kleine staatshervorming

Tijdschrift Bestuurskunde, Aflevering 4 2011
Trefwoorden scale, regions, territorial governance, state reform, intergovernmental collaboration
Auteurs Filip De Rynck, Joris Voets en Ellen Wayenberg
SamenvattingAuteursinformatie

    While the international community tries to picture what the future of Belgium as a country will be, the different regions (Flanders, Wallonia and Brussels) deal with issues of territorial governance like amalgamations, the future of provinces, city-regions and intergovernmental collaboration. The article maps these issues, but also which facts, interests and arguments are brought to the table, and to what extent policy agendas in the three regions are similar or not. In Wallonia and Flanders, the existence of the provincial tier is questioned and intermunicipal collaboration should become more important. Amalgamation of municipalities is discussed openly in Flanders - with little success so far, while such a debate is absent in Wallonia. The authors zoom in on the debate in Flanders, showing how rich the landscape of intergovernmental and public-private collaboration is, which variations exist, how each policy sector creates and protects its ‘own’ regional turf, how political debate on ‘cleaning up the mess of regional organisations’ requires nuancing, and how the Belgian political culture shapes that sectoral regional landscape. The authors build on two regional mappings, combining descriptive information with input from the interactive processes with different stakeholders on issues of efficiency, effectiveness, and accountability.


Filip De Rynck
Prof. dr F. De Rynck is professor Bestuurskunde aan het Departement Handelswetenschappen en Bestuurskunde aan de Hogeschool Gent.

Joris Voets
Dr J. Voets is senior onderzoeker aan het Instituut voor de Overheid, Katholieke Universiteit Leuven.

Ellen Wayenberg
Prof. dr E. Wayenberg is docent Bestuurskunde aan het Departement Handelswetenschappen en Bestuurskunde aan de Hogeschool Gent.
Artikel

Politieke ambtenaren?

Formele en feitelijke rolverschillen tussen Nederlandse politiek assistenten en vlaamse kabinetsmedewerkers

Tijdschrift Bestuurskunde, Aflevering 2 2011
Trefwoorden Political administrative relations, Flanders, The Netherlands, central government
Auteurs Diederik Vancoppenolle, Mirko Noordegraaf en Martijn van der Steen
SamenvattingAuteursinformatie

    A surprising difference between the Netherlands and Flanders is that a Flemish minister may appoint more than 20 advisors, while Dutch ministers can appoint only one or two ‘political assistants’. However, this difference was hardly studied before, although it is a relevant and actual theme. This article analyzes the differences in role and position of Flemish ministerial advisors and Dutch political assistants. We show that there exist large differences between both types of advisors and we discuss the reasons for and consequences of this difference. The institutional context in which both actors work determines a lot their role. Differences in political culture and administrative organization in particular seem to be important explanatory factors.


Diederik Vancoppenolle
Dr Diederik Vancoppenolle is doctor-assistent aan het departement Handelswetenschappen & Bestuurskunde van de Hogeschool Gent (België).

Mirko Noordegraaf
Prof. dr M. Noordegraaf is hoogleraar Publiek Management aan de Utrechtse School voor Bestuurs- en Organisatiewetenschap (USBO) van de Universiteit Utrecht.

Martijn van der Steen
Dr M. van der Steen is codecaan en adjunct-directeur van de Nederlandse School voor Openbaar Bestuur (NSOB).
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