textOver the past decades health economics has emerged as a new scientific discipline.
From the very beginning the field has continued to expand and take on increasing
significance. An important focus is on the economic evaluation of health care
facilities withln the area of Medical Technology Assessment (MTA) or Health
Technology Assessment (HTA). Other topics studied by health economists regard
among others the demand for care, the role of health insurance, the industrial
organisation of the health care sector and the international comparison of health
care systems.
Cost-of-illness (COI) studies have also attracted the attention of health
economists. Since the pioneering work of Dorothy Rice in the United States in the
Sixties [Rice 1966], cost-of-illness data have been published for several countries.
There is, however, some controversy about the results. Physicians and
policymakers frequently ask what the often very large financial estimates for costs
of specific diseases mean and how reliable, valid and useful they are. This thesis
focuses on COI studies. We will start with a few definitions [Rice 1994].

https://repub.eur.nl/pub/23537/011010_Polder,%20Johannes%20Jacob.pdf

Cost of Illness in the Netherlands: description, comparison and projection

This thesis deals with the matter of making reforms in engineering education, and it highlights the significance of delivering a more comprehensive image of technology and its different aspects in the course of training students about technology and engineering. The innovative contribution of the thesis lies in its approach of taking advantage of the philosophy of engineering/technology.

/pdf/educating-future-engineers-and-the-image-of-technology-tw97a0py3o.pdf

Educating Future Engineers and the Image of Technology : Applying the Philosophy of Technology to Engineering Education

Engineering, as a complex and multidimensional practice of technology development, has long been a source of ethical concerns. These concerns have been approached from various perspectives. There are ongoing debates in the literature of the philosophy of engineering/technology about how to organize an optimized view of the values entailed in technology development processes. However, these debates deliver little in the way of a concrete rationale or framework that could comprehensively describe different types of engineering values and their multi-aspect interrelations in real engineering practices. Approaching engineering values from a meaning-based perspective, as in this paper, can be a reliable method of tackling such a controversial problem. This paper therefore proposes that technology development be considered a systemic normative practice and attempts to provide a comprehensive view of various built-in values, their different origins and features, and a way of prioritizing them in real engineering processes. Studying two cases of the Zayandeh Rood Dam and the Abbasi Dam will lead to practical insights into how to understand norms in technology development and incorporate them into engineering practice.

/pdf/technology-development-as-a-normative-practice-a-meaning-2voc26tfx4.pdf

Technology Development as a Normative Practice : A Meaning-Based Approach to Learning About Values in Engineering—Damming as a Case Study

This article develops a conceptual framework of norm-responsive aspects of psychiatric practice This framework is meant to support and conceptualize the idea that the practice of psychiatry is inherently value laden and responding to norms, principles, values, and ideals I argue that these norms, principles, values, and ideals manifest a certain order, with qualifying, foundational, and conditioning norms and principles on the one hand and regulative ideals and core values on the other hand These norms and principles are constitutive for psychiatric practice and define its inherently normative conditions They are necessary elements, without which the practice of psychiatry cannot properly be understood The core values and ideals on the other hand are the expression of ultimate concerns and an instantiation of the ethos of the profession This ethos harbors an implicit worldview and orients and directs psychiatric practice to the kind of endeavor it is meant to be The inherent normative nature of psychiatric practice is first approached by analyzing the web of relations that shape the interactions between professionals and patients This exposition is followed by an analysis of the different norms and values that are operational within psychiatric practice itself This analysis leads to the delineation of a normative practice approach of psychiatric practice The distinction between different types of norms helps to elucidate weaknesses of scientistic and technicistic approaches in psychiatry I show how the normative practice approach provides a richer, more nuanced, and more convincing account of psychiatry’s legitimacy

Psychiatry as normative practice

Professional autonomy interferes at a structural level with the various aspects of the health care system. The health care systems that can be distinguished all feature a specific design of professional autonomy, but experience their own governance problems. Empirical health care systems in the West are a nationally coloured blend of ideal type health care systems. From a normative perspective, the optimal health care system should consist of elements of all the ideal types. A workable optimum taking national values into account could be attained by governance structures that also introduce elements from other ideal type systems. Thus a normative approach to medical practice guaranteeing an essential degree of professional autonomy for a relationship of trust between the patient and the physician, could be combined with an efficient and equitable allocation of health care resources.

Johan J. Polder

Papers

Profession, practice and profits: competition in the core of health care system