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Papers by Richard T.j.m Janssen

Research paper thumbnail of Symptomatic and Functional Remission in Young Adults with a Psychotic Disorder in a Rehabilitation Focused Team

Community Mental Health Journal

The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a ... more The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR.

Research paper thumbnail of Effect of reimbursement restriction policy on the use of benzodiazepines in the Netherlands: an interrupted time series analysis

BMJ Open

ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherland... more ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use.DesignInterrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis.SettingA 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015.Participants2 500 800 benzodiazepine prescriptions from 128 603 patients were included.InterventionReimbursement restriction policy from January 2009 onwards.Outcome measuresChanges in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuat...

Research paper thumbnail of Cost Sharing Does Not Lead to an Overall Increase of Involuntary Commitments in the Netherlands-Reply

Research paper thumbnail of A Cost-Effectiveness Analysis to Evaluate a System Change in Mental Healthcare in the Netherlands for Patients with Depression or Anxiety

Administration and policy in mental health, Jan 15, 2017

Over the last decade, the Dutch mental healthcare system has been subject to profound policy refo... more Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p < 0.001), with similar health outcomes as in the old system.

Research paper thumbnail of Concurrentie en rivaliteit tussen ziekenhuizen

ABSTRACT Concurrentie is een belangrijk instrument om de efficiëntie in de gezondheidszorg te bev... more ABSTRACT Concurrentie is een belangrijk instrument om de efficiëntie in de gezondheidszorg te bevorderen. In dit artikel worden ontwikkelingen in de marktstructuur van ziekenhuisvoorzieningen met behulp van diverse concentratie-indices in kaart gebracht. De resultaten wijzen uit dat er in geen enkele regio wordt voldaan aan de voorwaarden van volledig mededinging. Wel is de rivaliteit in stedelijke regio&amp;#39;s groter dan die in de rest van Nederland.

Research paper thumbnail of Privé-klinieken nader onderzocht

Medisch Contact, May 14, 1993

Research paper thumbnail of Wonen, ruimtelijke ordening en verschillen in gezondheid vanuit bestuurlijk perspectief

Research paper thumbnail of De GGD als contractpartij

public health contracting in the Netherlands

Research paper thumbnail of Op weg naar gepaste geestelijke gezondheidszorg

Research paper thumbnail of Verkenning van fusie-effecten in de ouderenzorg: Leiden verticale fusies tot betere zorg

Research paper thumbnail of Een analyse van de onderhandelingskracht van verzekeraars ten opzichte van ziekenhuizen

Acta hospitalia

De markt van gezondheidszorg verschilt aanzienlijk van andere markten. Over het algemeen is er sp... more De markt van gezondheidszorg verschilt aanzienlijk van andere markten. Over het algemeen is er sprake van een scheiding tussen beslissen, betalen en consumptie. De patiënt consumeert zorg, de arts-agent neemt de consumptiebeslissing en de ziektekostenverzekeraar betaalt de zorg. De voorgenomen stelselwijziging in Nederland voorziet dat verzekeraars onderhandelen met ziekenhuizen over een optimale prijs-kwaliteit verhouding van het zorgprodukt respectievelijk over verbetering van kwaliteit en service alsmede het volume van zorg. Deze bijdrage richt zich op de vraag in hoeverre sprake is van onderhandelingskracht van verzekeraars ten opzichte van ziekenhuizen. Hierbij staat het model van Porter (1980) centraal. Porter noemt een achttal factoren aan de hand waarvan de onderhandelingskracht kan worden bepaald. Deze zijn de concentratie van verzekeraars versus die van ziekenhuizen, de kosten van het zorgprodukt, de hoogte van de switching costs, het belang van de kwaliteit van het zorgpr...

Research paper thumbnail of Ontwikkeling van de marktstructuur van Nederlandse ziekenhuizen 1978 tot 2013

Tijdschrift voor gezondheidswetenschappen, 2014

Research paper thumbnail of Time prices and the demand for GP services

Social science & medicine (1982), 1992

This paper analyzes the effects of time prices on the demand for general practitioner (GP) servic... more This paper analyzes the effects of time prices on the demand for general practitioner (GP) services. Where data on earnings per unit of time was not available, an alternative method was used to impute the value of time. Separate elasticities were estimated using interactive dummy variables for individual employment status. Furthermore, a distinction was made between patient-initiated and physician-initiated visits to a GP. The results show that the probability of a patient-initiated visit is negatively influenced by the time required, for 4 of the 6 employment status categories defined. For a subsample, time was valued on the basis of earnings per time unit. The resulting time price was found to have a significant negative impact on the probability of a patient-initiated visit to a GP. However neither time nor time prices have any effect on the probability of a physician-initiated visit. It can therefore be concluded that time prices are a relevant factor in the determination of dem...

Research paper thumbnail of Hospital management by product lines

Health services management research : an official journal of the Association of University Programs in Health Administration / HSMC, AUPHA, 1991

Over the last decennium many reforms of the reimbursement systems have taken place to improve the... more Over the last decennium many reforms of the reimbursement systems have taken place to improve the economic performance of health service organizations. These environmental changes have stimulated many hospital managers to introduce types of internal management control. Consequently budgeting is a very well known management tool. Less known in Europe is product-line management. The main purpose of this article is to introduce the concept of product-line management. Attention is paid to ways product lines can be defined in hospitals and which elements the implementation of product-line management envelope. Emphasis is laid on the consequences for the organizational structure and the cost information system. Finally, we deal with the advantages and disadvantages of product-line management.

Research paper thumbnail of De markt van ziekenhuisdiensten. Resultaten in het verleden bieden garantie voor de toekomst?

European Journal of Operational Research - EJOR, 2006

Research paper thumbnail of Klant is koning: ook in de zorg?

Research paper thumbnail of Centrale tarieven, te veel zorg

Research paper thumbnail of De ontwikkeling van de marktstructuur van klinische ziekenhuiszorg, een ontwikkeling in kaart gebracht

Research paper thumbnail of Ambulancezorg gebudgetteerd en gemanaged

Research paper thumbnail of De jaarrekening

Research paper thumbnail of Symptomatic and Functional Remission in Young Adults with a Psychotic Disorder in a Rehabilitation Focused Team

Community Mental Health Journal

The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a ... more The aim of this study is to assess symptomatic remission (SR) and functional remission (FR) in a rehabilitation focused program for young adults with a psychotic disorder in the Netherlands, and to investigate which individual and mental health care factors are associated with SR and/or FR, by using Routine Outcome Monitoring data and data on met needs and unmet needs for care. Data of 287 young adults were collected. Almost 40% achieved or maintained SR, 34% FR, and 26% achieved or maintained both. In addition to sociodemographic factors, living independently, paid employment, higher levels of compliance with treatment, and better fulfillment of unmet needs for care in relation to psychological distress, company and daytime activities were associated with better outcomes on SR and/or FR. Our findings underscore that to successfully improve and sustain remission in young adults with a psychotic disorder, it is needed to conduct specific research into the relationship between SR and FR.

Research paper thumbnail of Effect of reimbursement restriction policy on the use of benzodiazepines in the Netherlands: an interrupted time series analysis

BMJ Open

ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherland... more ObjectivesUse of benzodiazepines has health risks. Reimbursement was restricted in the Netherlands from January 2009 onwards with the goal to reduce chronic use and healthcare expenditures. The aim of this study is to assess the initial and long-term effects of this policy on benzodiazepine use.DesignInterrupted time series analysis, segmented regression models, Kaplan-Meier survival analysis and Cox proportional hazards analysis.SettingA 10% random sample of benzodiazepine dispensings by outpatient pharmacies between January 2002 and August 2015 were obtained from the PHARMO database. This database covered a catchment area representing about 3.6 million residents in 2015.Participants2 500 800 benzodiazepine prescriptions from 128 603 patients were included.InterventionReimbursement restriction policy from January 2009 onwards.Outcome measuresChanges in: the volume of dispensed prescriptions and doses, the incidence, prevalence of incidental, regular and chronic use and discontinuat...

Research paper thumbnail of Cost Sharing Does Not Lead to an Overall Increase of Involuntary Commitments in the Netherlands-Reply

Research paper thumbnail of A Cost-Effectiveness Analysis to Evaluate a System Change in Mental Healthcare in the Netherlands for Patients with Depression or Anxiety

Administration and policy in mental health, Jan 15, 2017

Over the last decade, the Dutch mental healthcare system has been subject to profound policy refo... more Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p < 0.001), with similar health outcomes as in the old system.

Research paper thumbnail of Concurrentie en rivaliteit tussen ziekenhuizen

ABSTRACT Concurrentie is een belangrijk instrument om de efficiëntie in de gezondheidszorg te bev... more ABSTRACT Concurrentie is een belangrijk instrument om de efficiëntie in de gezondheidszorg te bevorderen. In dit artikel worden ontwikkelingen in de marktstructuur van ziekenhuisvoorzieningen met behulp van diverse concentratie-indices in kaart gebracht. De resultaten wijzen uit dat er in geen enkele regio wordt voldaan aan de voorwaarden van volledig mededinging. Wel is de rivaliteit in stedelijke regio&amp;#39;s groter dan die in de rest van Nederland.

Research paper thumbnail of Privé-klinieken nader onderzocht

Medisch Contact, May 14, 1993

Research paper thumbnail of Wonen, ruimtelijke ordening en verschillen in gezondheid vanuit bestuurlijk perspectief

Research paper thumbnail of De GGD als contractpartij

public health contracting in the Netherlands

Research paper thumbnail of Op weg naar gepaste geestelijke gezondheidszorg

Research paper thumbnail of Verkenning van fusie-effecten in de ouderenzorg: Leiden verticale fusies tot betere zorg

Research paper thumbnail of Een analyse van de onderhandelingskracht van verzekeraars ten opzichte van ziekenhuizen

Acta hospitalia

De markt van gezondheidszorg verschilt aanzienlijk van andere markten. Over het algemeen is er sp... more De markt van gezondheidszorg verschilt aanzienlijk van andere markten. Over het algemeen is er sprake van een scheiding tussen beslissen, betalen en consumptie. De patiënt consumeert zorg, de arts-agent neemt de consumptiebeslissing en de ziektekostenverzekeraar betaalt de zorg. De voorgenomen stelselwijziging in Nederland voorziet dat verzekeraars onderhandelen met ziekenhuizen over een optimale prijs-kwaliteit verhouding van het zorgprodukt respectievelijk over verbetering van kwaliteit en service alsmede het volume van zorg. Deze bijdrage richt zich op de vraag in hoeverre sprake is van onderhandelingskracht van verzekeraars ten opzichte van ziekenhuizen. Hierbij staat het model van Porter (1980) centraal. Porter noemt een achttal factoren aan de hand waarvan de onderhandelingskracht kan worden bepaald. Deze zijn de concentratie van verzekeraars versus die van ziekenhuizen, de kosten van het zorgprodukt, de hoogte van de switching costs, het belang van de kwaliteit van het zorgpr...

Research paper thumbnail of Ontwikkeling van de marktstructuur van Nederlandse ziekenhuizen 1978 tot 2013

Tijdschrift voor gezondheidswetenschappen, 2014

Research paper thumbnail of Time prices and the demand for GP services

Social science & medicine (1982), 1992

This paper analyzes the effects of time prices on the demand for general practitioner (GP) servic... more This paper analyzes the effects of time prices on the demand for general practitioner (GP) services. Where data on earnings per unit of time was not available, an alternative method was used to impute the value of time. Separate elasticities were estimated using interactive dummy variables for individual employment status. Furthermore, a distinction was made between patient-initiated and physician-initiated visits to a GP. The results show that the probability of a patient-initiated visit is negatively influenced by the time required, for 4 of the 6 employment status categories defined. For a subsample, time was valued on the basis of earnings per time unit. The resulting time price was found to have a significant negative impact on the probability of a patient-initiated visit to a GP. However neither time nor time prices have any effect on the probability of a physician-initiated visit. It can therefore be concluded that time prices are a relevant factor in the determination of dem...

Research paper thumbnail of Hospital management by product lines

Health services management research : an official journal of the Association of University Programs in Health Administration / HSMC, AUPHA, 1991

Over the last decennium many reforms of the reimbursement systems have taken place to improve the... more Over the last decennium many reforms of the reimbursement systems have taken place to improve the economic performance of health service organizations. These environmental changes have stimulated many hospital managers to introduce types of internal management control. Consequently budgeting is a very well known management tool. Less known in Europe is product-line management. The main purpose of this article is to introduce the concept of product-line management. Attention is paid to ways product lines can be defined in hospitals and which elements the implementation of product-line management envelope. Emphasis is laid on the consequences for the organizational structure and the cost information system. Finally, we deal with the advantages and disadvantages of product-line management.

Research paper thumbnail of De markt van ziekenhuisdiensten. Resultaten in het verleden bieden garantie voor de toekomst?

European Journal of Operational Research - EJOR, 2006

Research paper thumbnail of Klant is koning: ook in de zorg?

Research paper thumbnail of Centrale tarieven, te veel zorg

Research paper thumbnail of De ontwikkeling van de marktstructuur van klinische ziekenhuiszorg, een ontwikkeling in kaart gebracht

Research paper thumbnail of Ambulancezorg gebudgetteerd en gemanaged

Research paper thumbnail of De jaarrekening

Research paper thumbnail of Association of Cost Sharing With Mental Health Care Use, Involuntary Commitment, and Acute Care

IMPORTANCE A higher out-of-pocket price for mental health care may lead not only to cost savings ... more IMPORTANCE A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences. OBJECTIVE To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use.