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Climatic changes can cause unpredictability in flood regimes that traditional flood risk management (FRM) approaches may struggle with. Therefore, flood resilience is seen as a supplementation to these approaches, putting a larger emphasis on flood acceptance and minimising consequences. An (emergent) group contributing towards flood resilience is civil society. This paper examines how civil society contributions can be furthered and guided in the Netherlands as well as exploring potential limitations in doing so. To achieve this, England is used as a good practice example due to a more developed and defined role for civil society being present here. Data were collected on both actual (England and the Netherlands) and potential (The Netherlands) civil society contributions. These were compared to identify potential avenues for Dutch civil society contributions to flood resilience that can be further investigated. The research shows that the most promising avenues are improving advocacy from citizens, improving local flood awareness and developing relationships between FRM authorities and existing citizen groups that can be harnessed and mobilised to support flood resilience. Additionally, the research also provides insights into potential limitations for transferring resilience approaches from one context to another beyond the cases discussed in this publication. [ABSTRACT FROM AUTHOR]

Both England and the Netherlands have seen efforts to liberalise their audit markets for local government in recent decades. According to economic theory, these should benefit buyers as increased competition produces lower prices and improved quality. Increasing the number of competing audit firms in markets traditionally dominated by few large firms is widely seen as a key ingredient to this process. However, liberalisation has taken different paths in England, compared to the Netherlands. In England, a national‐level collaborative purchasing arrangement has seen a small number of large firms competing, whilst in the Netherlands, a free market has led to the withdrawal by Big‐4 firms and rapidly growing market share by mid‐tier and small firms. In this paper, we analyse contrasting market developments in local public audit in England and the Netherlands and accordingly analyse the underlying factors through applying an established framework for market analysis from industrial economics, Porter's five forces framework, together with an institutional logics approach to further understand the factors involved. We find the Porter framework a useful tool to identify structural differences between markets but one that requires further analysis to explain underlying dynamics, which in the case of Dutch and English local public audit markets is effectively provided by the use of concepts from institutional logics including a historical contingency analysis. [ABSTRACT FROM AUTHOR]

Objective: Due to cardiovascular safety concerns, the European Medicines Agency (EMA) recommended new contraindications and changes to product information for diclofenac across Europe in 2013. This study aims to measure their impact among targeted populations. Method: Quarterly interrupted time series regression (ITS) analyses of diclofenac initiation among cohorts with contraindications (congestive cardiac failure [CHF], ischaemic heart disease [IHD], peripheral arterial disease [PAD], cerebrovascular disease [CVD]) and cautions (hypertension, hyperlipidaemia, diabetes) from Denmark, the Netherlands, England and Scotland. Results: The regulatory action was associated with significant immediate absolute reductions in diclofenac initiation in all countries for IHD (Denmark −0.08%, 95%CI −0.13, −0.03; England −0.09%, 95%CI −0.13 to −0.06%; the Netherlands −1.84%, 95%CI −2.51 to −1.17%; Scotland −0.34%, 95%CI −0.38 to −0.30%), PAD and hyperlipidaemia, the Netherlands, England and Scotland for hypertension and diabetes, and England and Scotland for CHF and CVD. Post‐intervention there was a significant negative trend in diclofenac initiation in the Netherlands for IHD (−0.12%, 95%CI −0.19 to −0.04), PAD (−0.13%, 95%CI −0.22 to −0.05), hypertension, hyperlipidaemia and diabetes, and in Scotland for CHF (−0.01%, 95%CI −0.02 to −0.007%), IHD (−0.017, 95%CI −0.02, −0.01%), PAD and hypertension. In England, diclofenac initiation rates fell less steeply. In Denmark changes were more strongly associated with the earlier EMA 2012 regulatory action. Conclusion: Although significant reductions in diclofenac initiation occurred, patients with contraindications continued to be prescribed diclofenac, the extent of which varied by country and target condition. Understanding reasons for such variation may help to guide the design or dissemination of future safety warnings. [ABSTRACT FROM AUTHOR]

Policy PointsStrategically purchasing health care has been and continues to be a popular policy idea around the world.Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing.Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. Context: Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. Methods: We conducted three in‐depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. Findings: No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. Conclusions: Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create. [ABSTRACT FROM AUTHOR]

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Context Patient-reported outcomes (PROs) can play an important role in patient-centered health care by focusing on the patient's health goals guiding therapeutic decisions. When aggregated, PROs also can be used for other purposes, including comparative effectiveness research, practice improvement, assessment of the performance of clinicians and organizations, and as a metric for value-based payments. The feasibility of integrating the use of PROs for these various purposes on a wide scale has not yet been demonstrated. Our study was conducted to inform policymakers of prudent next steps for implementing PROs in clinical practice and performance measurement programs in order to maximize their impact on the quality of health care. Methods We conducted a qualitative study, interviewing 58 experts and leaders from 37 organizations (response rate: 88%) in the United States, England, and the Netherlands. Respondents included clinical practitioners ( n = 30), measure developers ( n = 11), and leaders of performance measurement programs ( n = 17). We used a qualitative content analysis to assess current strategies for applying PROs in clinical practice and performance measurement and to identify barriers to and facilitators of further implementation. Findings The use of PROs in clinical practice and for performance measurement has developed both separately and in parallel. Experts across the stakeholder spectrum support the collection of PRO data in an integrated manner that would enable using the data for these distinct purposes. We identified 2 main concerns about the feasibility for integrated use of PRO data: the complexity of establishing routine data collection and the tension among stakeholders when using PRO data for different purposes. These contrasting stakeholder views suggested varying interests among clinicians, measure developers, and purchasers of care. Conclusions Data collection approaches that support the use of PROs in health care are underdeveloped, need better integration with clinical care, and must be tailored to the characteristics of the health care system. Enabling the sustainable use of PROs will require a shared vision of clinical professionals, purchasers, and patients, with a prudent selection of the steps in implementing PROs that will maximize their impact on the quality of health care. [ABSTRACT FROM AUTHOR]