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Clark NL, Coe D, Newell N, Jones MNA, Robb M, Reaich D, Wroe C. "I am in favour of organ donation, but I feel you should opt-in"-qualitative analysis of the #options 2020 survey free-text responses from NHS staff toward opt-out organ donation legislation in England. BMC Med Ethics 2024; 25:47. [PMID: 38643137 PMCID: PMC11031982 DOI: 10.1186/s12910-024-01048-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/17/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND In May 2020, England moved to an opt-out organ donation system, meaning adults are presumed to be an organ donor unless within an excluded group or have opted-out. This change aims to improve organ donation rates following brain or circulatory death. Healthcare staff in the UK are supportive of organ donation, however, both healthcare staff and the public have raised concerns and ethical issues regarding the change. The #options survey was completed by NHS organisations with the aim of understanding awareness and support of the change. This paper analyses the free-text responses from the survey. METHODS The #options survey was registered as a National Institute of Health Research (NIHR) portfolio trial [IRAS 275992] 14 February 2020, and was completed between July and December 2020 across NHS organisations in the North-East and North Cumbria, and North Thames. The survey contained 16 questions of which three were free-text, covering reasons against, additional information required and family discussions. The responses to these questions were thematically analysed. RESULTS The #options survey received 5789 responses from NHS staff with 1404 individuals leaving 1657 free-text responses for analysis. The family discussion question elicited the largest number of responses (66%), followed by those against the legislation (19%), and those requiring more information (15%). Analysis revealed six main themes with 22 sub-themes. CONCLUSIONS The overall #options survey indicated NHS staff are supportive of the legislative change. Analysis of the free-text responses indicates that the views of the NHS staff who are against the change reflect the reasons, misconceptions, and misunderstandings of the public. Additional concerns included the rationale for the change, informed decision making, easy access to information and information regarding organ donation processes. Educational materials and interventions need to be developed for NHS staff to address the concepts of autonomy and consent, organ donation processes, and promote family conversations. Wider public awareness campaigns should continue to promote the positives and refute the negatives thus reducing misconceptions and misunderstandings. TRIAL REGISTRATION National Institute of Health Research (NIHR) [IRAS 275992].
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Affiliation(s)
- Natalie L Clark
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, North Yorkshire, England, UK
| | - Dorothy Coe
- Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Tyne and Wear, England, UK
| | - Natasha Newell
- Centre for Process Innovation, Sedgefield, County Durham, England, UK
| | | | | | - David Reaich
- South Tees Hospitals NHS Foundation Trust, Middlesbrough, North Yorkshire, England, UK
| | - Caroline Wroe
- Newcastle-Upon-Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, Tyne and Wear, England, UK.
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Scheefhals ZTM, de Vries EF, Struijs JN, Numans ME, van Exel J. Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study. Soc Sci Med 2024; 340:116413. [PMID: 38000174 DOI: 10.1016/j.socscimed.2023.116413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/29/2023] [Accepted: 11/09/2023] [Indexed: 11/26/2023]
Abstract
Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.
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Affiliation(s)
- Zoë T M Scheefhals
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Eline F de Vries
- Department of Health Economics and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Jeroen N Struijs
- Department of National Health and Healthcare, Center for Public Health, Healthcare and Society, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Mattijs E Numans
- Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Center, The Hague, the Netherlands.
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, the Netherlands.
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Wiśniewska K, Girzelska J, Brodowicz-Król M, Chrzanowska U, Kulbaka E, Sierzantowicz R. Attitudes Toward Organ Transplantation. Transplant Proc 2023; 55:1-6. [PMID: 36690503 DOI: 10.1016/j.transproceed.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 01/23/2023]
Abstract
BACKGROUND The purpose of transplantation is to improve the health or save the life of the recipient. Although organ transplantation is a method generally accepted by society, there are still people who, referring to moral and ethical aspects, reject its validity. A great threat to transplantology is also the lack of knowledge of the society resulting from insufficient education. AIM The aim of this study was to find out attitudes and opinions about organ transplantation and to determine the level of acceptance of organ and tissue transplantation. METHODS The tool chosen for the study was a survey questionnaire. The research group consisted of 200 people. Approval from the Bioethics Committee was obtained to conduct the study. RESULTS The studies showed that more than half of the respondents (57%) would agree to organ donation for transplantation after the death of a loved one. Age was found to be statistically significant (P = .001). Older people showed more doubts about transplantation than people under 30. Over 80% of respondents agreed that initiatives to educate the public about transplantation are needed. CONCLUSIONS The respondents refer to transplantation positively as a method of treating and saving life, and more than half of respondents would agree to donate their organs for transplant after the death of a loved one. The majority of respondents described their attitude toward transplantation as positive, admitting that the objection to donating is due to the ignorance and too little awareness on the subject.
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Affiliation(s)
- Katarzyna Wiśniewska
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Joanna Girzelska
- Faculty of Health Sciences, Lublin Academy of WSEI, Lublin, Poland.
| | | | - Urszula Chrzanowska
- Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Białystok, Białystok, Poland
| | - Ewa Kulbaka
- Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, Lublin, Poland
| | - Renata Sierzantowicz
- Department of Surgical Nursing, Medical University of Białystok, Białystok, Poland
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Bongaerts THG, Büchner FL, Crone MR, van Exel J, Guicherit OR, Numans ME, Nierkens V. Perspectives on cancer screening participation in a highly urbanized region: a Q-methodology study in The Hague, the Netherlands. BMC Public Health 2022; 22:1925. [PMID: 36243684 PMCID: PMC9571478 DOI: 10.1186/s12889-022-14312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over recent years. Especially in highly urbanized regions the uptake rates tend to fall below the minimal effective rate of 70% set by the World Health Organization. Understanding the reasons underlying the decision of citizens to partake in a CPS are essential in order to optimize the current screening participation rates. The aim of this study was to explore the various perspectives concerning cancer screening among inhabitants of The Hague, a highly urbanized region of the Netherlands. METHODS A Q-methodology study was conducted to provide insight in the prevailing perspectives on partaking in CSPs. All respondents were inhabitants of the city of The Hague, the Netherlands. In an online application they ranked a set of 31 statements, based on the current available literature and clustered by the Integrated Change model, into a 9-column forced ranking grid according to level of agreement, followed by a short survey. Respondents were asked to participate in a subsequent interview to explain their ranking. By-person factor analysis was used to identify distinct perspectives, which were interpreted using data from the rankings and interviews. RESULTS Three distinct perspectives were identified: 1). "Positive about participation", 2). "Thoughtful about participation", and 3). "Fear drives participation". These perspectives provide insight into how potential respondents, living in an urbanized region in the Netherlands, decide upon partaking in CSPs. CONCLUSIONS Since CSPs will only be effective when participation rates are sufficiently high, it is essential to have insight into the different perspectives among potential respondents concerning partaking in a CSP. This study adds new insights concerning these perspectives and suggests several ideas for future optimization of the CSPs.
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Affiliation(s)
- Thomas H G Bongaerts
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands. .,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Frederike L Büchner
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Matty R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Centre for Health Economics Research, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Onno R Guicherit
- University Cancer Center Leiden - The Hague, at Haaglanden Medical Center, The Hague, The Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Perez-Garcia LF, Röder E, Pastoor H, Bolt JM, van Exel J, Dolhain RJEM. It is not just about sex: viewpoints of men with inflammatory arthritis on the overall impact of the disease on their sexual health. RMD Open 2021; 7:rmdopen-2021-001821. [PMID: 34580174 PMCID: PMC8477326 DOI: 10.1136/rmdopen-2021-001821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/10/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Sexual health is defined as a state of physical, emotional, mental and social well-being in relation to sexuality. The impact of inflammatory arthritis (IA) on male sexual health has been mainly studied focusing on erectile function, one of the physical components of sexual health. Our objective was to describe the viewpoints among men with IA in the Netherlands on the overall impact of IA on their sexual health. Methods Q-methodology, a mixed methods approach to systematically study subjectivity was used. Adult men diagnosed with IA ranked 34 opinion statements about potential impacts of IA on their sexual health and were interviewed. By-person factor analysis was used to identify common patterns in the rankings, which were interpreted as viewpoints. Data from the interviews were used to verify and adjust the interpretations. Results 30 men (22–77 years) with IA were included. The analysis revealed three viewpoints. Men with the viewpoint ‘Arthritis negatively affects my sexual health’ experience a dramatic impact on all components of sexual health. In viewpoint ‘I am keeping up appearances’, IA negatively impacts sexual health but a distinguishing coping mechanism could mask a more serious negative impact. Men with the viewpoint ‘I am satisfied with my sexual health’' experience no significant impact of IA on their sexual health. Conclusions We identified three viewpoints on the impact of IA on male sexual health, two revealed a negative influence that goes beyond the physical act of sex. IA can severely affect the emotional, mental and social components of sexual health.
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Affiliation(s)
| | - Esther Röder
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hester Pastoor
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Johanna M Bolt
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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AlHajri L, AlHebsi A, AlSuwaidi M. How context affects people's willingness to register for the deceased organ donation programme. BMC Public Health 2021; 21:729. [PMID: 33858361 PMCID: PMC8048161 DOI: 10.1186/s12889-021-10753-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The deceased organ donation programme is new in the United Arab Emirates (UAE), and to improve acceptability, a broad understanding of public perspectives is thought to be helpful. Therefore, this study aims to explore the extent to which context plays a role in the willingness to register for the deceased organ donation programme in Dubai, UAE. METHODS This study used a qualitative methodology and was gauged by the tenets of a social ecological model and lay knowledge. Audio-recorded semi-structured interviews were conducted with 17 participants. The data were subsequently analysed thematically. RESULTS Four themes emerged from the dataset: fear and body integrity, family, relational ties and the identification of the recipient, religious conviction, and knowledge and personal experiences. The participants feared the whole process, were not aware of the religious outlook, and their knowledge regarding the programme was scarce. In addition, family-related factors, such as parental authority and hierarchy in the family, were also major influencers. CONCLUSION Using the social ecological model and lay knowledge helped to unravel the contextual factors that affected the willingness of participants to register for the deceased organ donation programme in Dubai, UAE, thereby enabling the development of a holistic understanding of deceased organ donation. The responses mainly stemmed from participants' social contexts; hence, awareness campaigns should be tailored to inform people about the technical aspects and address their contextual concerns.
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Affiliation(s)
- Lamia AlHajri
- Department of Health Sciences, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates. .,Department of Health Research, Lancaster University, Lancashire, UK.
| | - Amna AlHebsi
- Department of Health Sciences, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
| | - Maryam AlSuwaidi
- Department of Health Sciences, Higher Colleges of Technology, Abu Dhabi, United Arab Emirates
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Rotteveel AH, Reckers-Droog VT, Lambooij MS, de Wit GA, van Exel NJA. Societal views in the Netherlands on active disinvestment of publicly funded healthcare interventions. Soc Sci Med 2021; 272:113708. [PMID: 33516087 DOI: 10.1016/j.socscimed.2021.113708] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/18/2020] [Accepted: 01/14/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To obtain public support for the active disinvestment (i.e. policy decision to stop reimbursement) of healthcare interventions, it is important to have insight in what the public thinks about disinvestment and which considerations they find relevant in this context. Currently, evidence on relevant considerations in the disinvestment context is limited. Therefore, this study aimed to explore the societal views in the Netherlands on the active disinvestment of healthcare interventions and obtain insight into the considerations that are relevant for those holding the different views. METHODS A Q-methodology study was conducted among a purposively selected sample of citizens (n = 43). Data were collected in June and July 2019. Participants individually ranked a set of 43 statements broadly covering the issues that participants could consider relevant in the disinvestment context, from 'least agree' to 'most agree'. Qualitative feedback on the statement ranking was collected from each participant using a questionnaire. Principal component analysis followed by oblimin rotation was used to identify clusters of participants with similar statement rankings. These clusters/factors were interpreted as distinct viewpoints using the factor arrays and qualitative questionnaire responses of participants. RESULTS Four viewpoints were identified. People holding viewpoint I believe that reimbursement of necessary healthcare should be maintained, irrespective of its costs. People holding viewpoint II agree with viewpoint I, although they believe that necessity should be objectively determined. People holding viewpoint III think that unnecessary, ineffective and inefficient healthcare should be disinvested. People holding viewpoint IV, consider it most important that disinvestment decision-making processes are transparent and consistent. CONCLUSION Insight in the distinct viewpoints identified in this study contributes to a better understanding of why it has been considered difficult to obtain public support for disinvestment of healthcare interventions, and can help policymakers to change their approach to disinvestment to increase public support.
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Affiliation(s)
- A H Rotteveel
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - V T Reckers-Droog
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - M S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - G A de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - N J A van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, the Netherlands
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Kostenzer J, de Bont A, van Exel J. Women's viewpoints on egg freezing in Austria: an online Q-methodology study. BMC Med Ethics 2021; 22:4. [PMID: 33407392 PMCID: PMC7789674 DOI: 10.1186/s12910-020-00571-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 12/21/2020] [Indexed: 01/02/2023] Open
Abstract
Background Egg freezing has emerged as a technology of assisted reproductive medicine that allows women to plan for the anticipated loss of fertility and hence to preserve the option to conceive with their own eggs. The technology is surrounded by value-conflicts and is subject to ongoing discussions. This study aims at contributing to the empirical-ethical debate by exploring women’s viewpoints on egg freezing in Austria,
where egg freezing for social reasons is currently not allowed. Methods Q-methodology was used to identify prevailing viewpoints on egg freezing. 46 female participants ranked a set of 40 statements onto a 9-column forced choice ranking grid according to the level of agreement. Participants were asked to explain their ranking in a follow-up survey. By-person factor analysis was used to identify distinct viewpoints which were interpreted using both the quantitative and the qualitative data. Results Three distinct viewpoints were identified: (1) “women should decide for themselves”, (2) “we should accept nature but change policy”, and (3) “we need an informed societal debate”. These viewpoints provide insights into how biomedical innovations such as egg freezing are perceived by women in Austria and illustrate the normative tensions regarding such innovations. Conclusions Acknowledging the different prioritizations of values regarding assisted reproductive technologies is important to better understand the underlying normative tensions in a country where egg freezing for social reasons is currently not allowed. The study adds new empirical insights to the ongoing debate by outlining and discussing viewpoints of those directly affected: women. Following up on the lay persons perspective is particularly important in the context of future biomedical innovations that may challenge established norms and create new tensions. It therefore also adds to the societal debate and supports evidence-informed policy making in that regard.
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Affiliation(s)
- Johanna Kostenzer
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | - Antoinette de Bont
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.,Erasmus School of Economics, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands
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