Research team

Economics

Expertise

My research expertise is in the field of health economics and has focused on a wide range of topics and analytic methods. Most research projects are typically applied empirical analyses for support of policy decisions. I have specific expertise in distributional issues from a theoretical as well as an empirical point of view. Empirical analyses relate to the impact of different financing arrangements on behavior and on problematic private payments for health care. Belgium and developing countries are studied. Economic evaluation (cost-effectiveness or cost-utility analysis) of drugs and medical technologies are a second main area of research. Performed studies have increased relevance and rigour, making use of refined methods and better data. They are performed in cross disciplinary cooperation. In addition applied policy research with respect to general issues in the organization of health care services is performed. Current research projects focus on the cost-effectiveness of MDR-TB injection administration by community treatment supporters in Eswatini (former Swaziland) and on performance based financing in DR Congo. Together with colleagues from the faculty of medicine we also conducted a cluster randomized controlled trial to optimize cost and workload during out of hours care by Triaging and Referring In Adjacent General and Emergency departments (the TRIAGE-trial).

Triaging and Referring In Adjacent General and Emergency departements (the TRIAGE-trial): a cluster randomised controlled trial. 01/10/2018 - 30/09/2021

Abstract

Introduction: Patients who might also go to the general practitioner (GP) frequently consult emergency departments (ED). This leads to additional costs for both government and patient and a high workload for emergency physicians in Flanders. The Belgian government wants to address this problem by improved collaboration between EDs and general practice cooperatives (GPCs). Intervention: Patients presenting at the ED during out-of-hours (OOH) will be triaged and allocated to the most appropriate service. For this purpose the Manchester Triage System (MTS) which is commonly used in Flemish hospitals, will be extended (eMTS). By doing so a trained nurse will be able to diverge suitable patients towards the GPC. Methodology: We will conduct a cluster RCT in which eligible ED patients will be diverged to the GPC using the eMTS. We will collect data using our operational anonymous database for OOH care (iCAREdata). We will study the use of the eMTS, the effectiveness and effects of triage, work load changes, epidemiology at both departments, patient safety, health insurance (HIS) and patient expenditures. Furthermore facilitators and barriers will be studied and an incident analysis of problem cases will be performed. Outcome: The primary outcome is the proportion of patients who enter the ED and are handled by the GP after triage. Secondary outcome measurements are related to safety: referral rate to the ED by the GP, proportion of patients visiting the ED again within two weeks, proportion of patients not following the triage advice and file review for selected patients. Results: We will generate a generic model of triage applicable to all Belgian EDs and GPCs. The model will consist of a validated triage instrument, a manual for setting up triage and scientific support for both effectiveness and safety. In addition we expect to achieve financial savings for the HIS and for the patient.

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Increased reimbursement and access to medical care 03/03/2017 - 01/07/2021

Abstract

We investigate the effects of lowering co-payments on medical consumption of low income families. To this end, we exploit a large scale, randomized policy intervention aimed at encouraging take-up of the Beneficiary of Increased Reimbursement Statute. We use administrative health insurance data to measure the budget impact and the effects on specific medical consumption patterns. We perform an additional survey to analyze the effect on subjective unmet need.

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Concerted research program in health economics at Kinshasa School of Public Health. 01/01/2018 - 31/12/2020

Abstract

DRC lacks necessary resources to provide efficient and equitable health services. Reinforcing local capacity is essential to constructively evaluate all health-care financing alternatives, to demonstrate the economic burden of health-related conditions, and to meaningfully determine the value of proposed programs and interventions, appropriate within the Congolese context. To provide efficient and equitable health services for improving the health of the Congolese population, the present project aims to: (1) set-up a concerted research program in health economics (HE) at the Kinshasa School of Public Health (KSPH); (2) strengthen the research capacities in HE at KSPH; and (3) increase the visibility and outreach of research activities and outputs in HE.

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Co-payments and the financial accessibility of medical care: an experimental investigation into the impact of lowering co-payments on patterns of medical consumption and unmet need. 01/10/2015 - 30/09/2016

Abstract

We study the effects of lowering co-payments on medical consumption of low income families. To this end, we exploit a large scale, randomized policy intervention aimed at encouraging take-up of the Beneficiary of Increased Reimbursement Statute. We use administrative health insurance data to measure the budget impact and the effects on specific medical consumption patterns. We perform an additional survey to analyze the effect on subjective unmet need.

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Er Terug-zijn³ - Re-integration of sub-acute incapacitated workers as an offer within the services of an external service for prevention and protection at work. 01/09/2010 - 31/12/2012

Abstract

This project represents a formal service agreement between UA and on the other hand IDEWE vzw. UA provides IDEWE vzw research results mentioned in the title of the project under the conditions as stipulated in this contract.

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Blood endothelium progenitor cells and dendritic cells as novel predictive biomarkers of in-stent restenosis after percutaneous coronary intervention. 01/01/2007 - 31/12/2009

Abstract

The main objective of the present project is to identify blood EPC and DC as novel predictive biomarkers of in-stent restenosis that can be used for developing of a more cost-effective provisional use of DES. This will be evaluated in a longitudinal, prospective observational clinical study in 250 consecutive patients who undergo elective PCI with a bare metal stent (Prokinetic) at the University Hospital of Antwerp.

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    Evaluation of the effects of the maximum bill on the consumption of health care. 15/10/2006 - 30/06/2008

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    High Technology Assessment of drug eluting stents. 01/10/2006 - 31/08/2007

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    The choice of out of hours medical care by young adults with children. A case study among residents in Deurne-Borgerhout. 01/03/2006 - 31/12/2007

    Abstract

    Little is known about preferences of consumers of out of office hours medical care. Discrete choice analysis allows quantification of these preferences. In Deurne Borgerhout (large city, large proportion of immigrants) we collect data from 300 respondents at consultations of child welfare centres. Data can be used to improve services to the community.

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    Drug policy in figures: follow-up study into the actors, public expenditure and target groups. 01/10/2005 - 30/06/2007

    Abstract

    In Belgium, the importance of research into public expenditure is emphasised in the federal policy document on drugs of 2001. To this end, the research "Drug policy in Figures, A study into the actors involved, public expenditure and target groups reached" (hereafter called Drugs in Figures I) was carried out between 2001 and 2003 by order of the then Belgian Federal Services for Scientific, Technical and Cultural Affairs, now the Belgian federal science policy office, under the promotorship of Prof. dr. B. De Ruyver. The present proposal will refine and update the methodology for measuring public expenditures as it was developed in the research Drugs in Figures I, taking into account the recent developments in the field, as well as the recommendations and bottle-necks identified in Drugs in Figures I and the studies recently carried out by (order of) the EMCDDA. The proposal pays more attention to the methodology itself and to the reporting on the methodology. Next to that, the research will perform a new measurement using the refined and updated methodology. In doing so, insight is gained into the evolutions in public expenditure concerning the approach to the drug problem in Belgium, highlighting the influence of the policy options and action points of the 2001 federal policy document on drugs. More specific, the present research intents to trace the existence of a relation between the priorities of the Belgian drug policy and the public expenditure for these priorities. Next to that, it will also be examined if a relation exists between the prioritized target groups of the Belgian drug policy and public expenditure for these target groups

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    Impact of supplements on access to medical care. 01/03/2005 - 31/07/2006

    Abstract

    Access to medical care is of primary concern to the government and the public in general. In this study, we will analyze whether the evolution in direct out-of-pocket payments (especially supplements) and private insurance has a negative impact on access. More specifically we will: -do a literature review on the effects of out-of-pocket payments and complementary private insurance; -calculate the amount and type of supplements in Belgium over the period 1996-2003 as well as determine the socio-economic characteristics of the patients generating or paying these supplements(on the basis of the IMA-data); -on the basis of appropriate econometric techniques *estimate the determinants to take out private health insurance *estimate the impact of supplementary private insurance on the probability and duration of hospitalization after correction for behavioral effect of supplements.

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    The dynamics of income, health and inequality. 01/03/2003 - 31/12/2006

    Abstract

    The policy background to the present proposal concern over equity in the fields of health and health care. This project aims to address the pertinent questions regarding the causal mechanisms underlying the systematic associations between health and income. It will mainly rely on theoretical advances in the health economics literature to guide the empirical analysis and take advantage of the availability panel date to test and estimate these relationships.

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    Costs related to hyperactivity (ADHD) in childhood. 01/03/2003 - 31/08/2003

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      The dynamics of income, health and inequality over the life cycle. (EQUITY III) 01/11/2002 - 31/10/2005

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      Costs related to hyperactivity in childhood: an exploration. 01/08/2002 - 31/01/2003

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      The aim of this study is threefold: a) to disseminate collected information on the willingness-to-pay for drugs to treat ADHD in studens b) to collect and summarise available evidence on the costs of the treatment of ADHD; c) to explore the feasibility of a WTP-study among patients.

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        Content and health economic translation of psychiatric care circuit youth and context. 01/10/2001 - 09/10/2002

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          Calculation of elements of health care financing according to WHO-methodology. 28/08/2001 - 30/09/2001

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            Equity of the different payment sources for health care 01/12/2000 - 31/10/2003

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            The project will provide further evidence on the sociale characteristics of the Belgian health care system and contribute to the existing international evidence on three different aspects. 1) Provide factual information about the link between an individual's income and its liability for user charges over time. To which degree has the increase in copayments led to an increased share of medical care in household income over time and what is the impact on poverty? 2) Analyse the current impact of health care payments on households. What individuals are most vulnerable with respect to medical payments? What are the demographic and clinical characteristics of patients having payment problems? 3) Analysis of the (actual) degree of vertical and horizontal equity of the different payment sources for health care in Belgium and international comparison.

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            Activity and pathology scores in intensive care (on behalf of the University hospital in Antwerp) 01/04/2000 - 31/12/2000

            Abstract

            The project will calculkate the real cost per patient for a mix of pathologies of patients hospitalised in the intensive care unit of The University Hospital of Antwerp. The methology of Activity Based Costing will be used and carefully evaluated. It will be analysed to which degree the cost of an anctivity is pathology-specific. For this comparison, data collected for project P105/p00508 will be analysed. Finally, it will be analysed whether scores of severity of illness can be sused for the toal cost per patient.

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              The analysis of cost behaviour in ICU: the relationship between costs, expenditures and capacity decisions and the impact of case mix. 01/01/2000 - 31/12/2000

              Abstract

              Insight in the real cost of treatment of patient is important when developing a fincancing system and also as internal policy in the hospital. The project will calculate the real cost per patient for cardiosurgery patients hospitalised in the intensive care unit of the University Hospital of Antwerp. Activity Based Costing is strongly recommended as cost methodology for cost assignment, also in the hospital setting. Still this method can be problematic when confronted with joint use of resources and indivisibility. In addition, there is a practial problem with respect to the unit of measurement: is it possible to determine the cost per activity in general, or is the cost per activity pathology-specific. The study will pay attention to both problems. First, the real cost per patient will be calculated on the basis of different cost methodologies. Second, a comparison will be made between the cost per patient for one pathology (cardiosurgery) with the cost for a mix of pathologies.

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                Economic determinats of medical consumption 01/02/1999 - 31/01/2001

                Abstract

                The policy background to the proposal is the continuing concern over equity in the field of health care. The aim of the project is to explore the role of user charges, private insurance and income in influencing health care utilistation. The structure of user charges will be analysed, especially their relationship with income, as well the effect of user charges on acces

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                  Financing models for hospital and transmural care, for application in a renewed flemish health care policy 01/10/1998 - 30/09/2000

                  Abstract

                  This research project aims at designing a number of scenarios for financing health care, taking in account the options of the Flemish government and the fundamental developments and tendencies in the health care area. The scenarios will focus on a number of important aspects of each financing system, being (1) integrated versus fragmented financing of care, (2) open ended versus close-end budgets, (3) fixed versus variable financing and (4) financing citeria. All of these will be evaluated in terms of their capacity to help realise the most important objectives of health care policy, being quality, equity and efficiency. The financing scenarios will be developed on the basis of literature review and field visits in Belgium and other countries, will be evaluated in terms of the adaptability to the flemish context.

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                    European Study on the cost-effectiveness of pneumococcal vaccination 01/11/1997 - 28/02/1998

                    Abstract

                    The project analyses he cost-effectiveness of pneumococcal vaccination of elderly above the age of 65, for at least five European countries, following an common methodology. The evaluation is performed from a social point of view. Costs include vaccine price, administration costs, treatment costs of vaccine-related side-effects and averted costs of hospitalisation for invasive pneumoccal infections. The effects are expressed in quality adjusted life-years.

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                      The use of antibiotics in a University Hospital 01/09/1997 - 31/08/1998

                      Abstract

                      The project analyses expenditures for antibiotics in a University Hospital. The evolution of price and quantity is followed. This shuld help in formulating a more rational antibiotic policy.

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                        Compensation arrangements between hospitals and physicians: an economic analysis. 01/10/1996 - 31/12/1998

                        Abstract

                        The project aims at analysing economic consequences of compensation arrangements between hospitals and physicians. Specifically, the focus is on the relation between hospital performance and compensation schemes such as fee-for-service, fee-splitting, pooling, salary, etc. This research is a specific application (with empirical evidence) of principal-agent and contract theory in the medical care industry.

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                          Evaluation study of the cost-effectiveness of a clinical study (concluded by hnp as sponsor). 01/05/1996 - 31/05/1996

                          Abstract

                          The promotor agreed to assist HNP in evaluating the cost-effectiveness of the following clinical study: 'Evaluation of tolerability and efficacy of Co-soltrim in comparison to Cotrimoxazole in the treatment of pneumocystiis carinii pneumonia in HIV+ patients. A prospective, randomized, double-(observer)-(blind), parallel group, multicenter and multinational phase III study', which is conducted by HNP as Sponsor.

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                            An Economic Assessment of the Influenza Vaccine for Belgium 01/04/1996 - 31/10/1996

                            Abstract

                            The research assignement is to carry out a cost-effectiveness analysis of influenza vaccination. Additional costs and effects of vaccination of the active population and of the elderly population (over 65) will be compared to the alternative of non-vaccination. The assessment is limited to the direct medical costs paid for by the patient or health insurance.

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                              Sickness absence and certification of work incapacity. 01/04/1992 - 31/12/1995

                              Abstract

                              This study will give insight in the certification of sickness absence by General Practitioners in Belgium. It will explore the factors that contribute to the prescribing of work incapacity and its duration. In addition the study will compare the magnitude of sickness absence in Belgium and its neighbour countries.

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                                A macro-economic model for health care in Belgium. 01/04/1992 - 31/12/1995

                                Abstract

                                It is the purpose to build an econometric model which clarifies the structure of the health services and their link to the national economy. Specifically, attention is paid to the modelling of the demand for several types of health care, the price determination, employment in this sector and their interactions. The expenditures of the National Health Insurances are endogenized within the HERMES-model of the Belgian economy. Finally, these expenditures are linked to employment of the main types of health care personnel.

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