Search

This report analyses the evolution and the role of industrial relations in the public sector in the Netherlands in the period 2000-2015, focussing on three sub-sectors: hospitals, primary education and municipalities and their task of re-integrating jobseekers. After introducing the Dutch public sector, public sector reforms, and industrial relations, the parts on sub-sectors discuss 1) changes in industrial relations and the shape of public sector reform; 2) the influence of social partners on reform processes and implementation; and 3) effects of reforms on employment and, in turn, effects of the latter on availability and quality of public services. The role of the financial and economic crisis is a recurring theme in addressing these topics. Our in-depth analysis of the various sub-sectors is based on statistical data, documents and interviews with social partners and policy makers. We find that for hospitals, municipalities, and primary education, the landscape of actors has remained stable overall. However, patterns of interaction of the social partners varied from somewhat more consensual in the hospital sector to less consensual in municipalities where collective agreement negotiations were long-drawn and sometimes got held up by industrial action. The latter was also the case in the primary education sector, which recently saw widespread collective action. Furthermore, all sub-sectors experienced major systemic changes between 2000-2015, although the speed differed: municipalities saw stepwise reforms in re-integration and a large reform in 2015. Hospitals were confronted with systemic health system change in 2006. In primary education, schools’ financing method changed to lump-sum financing. Social partners mainly used lobbying strategies towards the central government, however, with differences in intensity between employers and trade unions across sub-sectors and over time. Next, effects of reforms on employment included mixed developments in terms of employment numbers and consequences in terms of e.g. higher work pressure and crisis-induced zero-wage policies in some sub-sectors. Finally, effects of changes in employment on public service provision are hard to establish because of other influences, but the risk of deterioration of services is recognized by especially trade unions despite notable efforts to increase public transparency of quality, for instance in hospitals, and professionalization, for instance in municipal re-integration services.

Economic research has widely analysed the effects of institutions and policies on the economy and labour markets. However, while a lot of comparative work has been done on welfare states, there is much less theoretical work about employment institutions across countries. Better insight into in these patterns of employment institutions is needed because differences between countries in that respect are possibly related to differences in the valuation of work. In order to investigate the relationship, first, the institutions concerning employment including labour relations need to be systematically examined. This paper asks the following questions: What sorts of patterns do we see for OECD and EU countries when looking at different aspects of employment institutions, which clusters of countries can be distinguished, and how do they differ? We present the results of an institutional analysis as part of a larger project on the relationship about societal appreciation of the value of work, including different types of employment, and employment institutions. To this end, we use institutional indicators in the areas of the individual employment relationship, the collective employment relationship, employment conditions, labour market transitions, and the relationship between work and care, making use of data from several comparative databases. The results show the breadth of patterns of employment institutions in developed countries in OECD and EU countries grouped together in five distinctive clusters.

Over the past almost 50 years several calcium concentrations in the dialysate (CaD) have been used to balance calcium in hemodialysis (HD) patients but a consensus as to which is most appropriate has not been established. Moreover, since the late 1980s, further confusion has been caused following the use of calcium salts as intestinal phosphate binders. This paper reports results of 3 87 chronic HD patients with respect to secondary hyperparathyroidism (sHPT) and renal osteodystrophy (ROD) of a single center over 20 years. The most important therapeutic measures applied were use of only 2 CaD, 1.5 and 1.75 mmol/l, with very few exceptions, administration of either calcium-containing or calcium-magnesium-containing and/or calcium-free phosphate binders, no dietary restrictions and continuous compensation of uremic acidosis via dialysate and oral supplements of bicarbonate. Using one of the two CaD and selective administration of different phosphate binders for fine adjustment of serum calcium through this combination, we were able to maintain in the long term almost physiological conditions. With exception of the phosphate metabolism, most physiological functions with regard to sHPT and ROD returned close to normal. As a result, the incidence ofhypercalcemia, hypocalcemia, extra-osseous, extravascular calcification, bone pain and spontaneous bone fractures was extremely low. We conclude that the clinical advantages of the therapeutic measures, above all precise balance of calcium homeostasis, in our investigation were demonstrated by high survival rates (92% after the first year on HD, 82% after 2, and 55% after 5 years), low incidence of cardiovascular fatalities (about 25%), and very low incidence of sHPT (mostly normal parathyroid hormone levels, 1 parathyr-doidectomy within 20 years).

In recent years, methods of on-line urea concentration and on-line urea clearance monitoring have been proposed for control of dialysis dose (Kt/V) and protein catabolic rate (PCR) in patients on regular dialysis therapy; these offer an alternative to the established methods of urea kinetics based on pre- and post-dialysis measurements of urea concentration. In contrast to such conventional urea kinetics, the new methods deliver results in real time and treatment parameters can be changed instantly. Three on-line measurement methods are to be distinguished: monitoring of urea concentration in ultrafiltrate, monitoring of urea concentration in dialysate (both yield Kt/V and PCR), and monitoring of urea clearance based on conductivity measurements. Some of these approaches are already applied commercially. Here, these methods are compared using results obtained from laboratory and clinical studies. The on-line methods are found to be more accurate than methods based on pre- and post-dialysis urea concentrations, and to be better suited for clinical routine. This paper outlines the principal methods, reviews the present literature, gives an overview of the applications and compares them to conventional pre- and post-dialysis concentration-based methods of urea kinetics. It is concluded that these methods are likely to find a widespread application in the control of dialysis adequacy.

Border regions and border effects currently attract a lot of attention in political practice and economic research. Substantial interest in regions located along the frontiers of integrating countries is predominantly inspired by the presumption that their specific geographic position might cause peculiarities in economic adjustments to integration. This survey explores whether economic theory and empirical studies support the assessment that integration effects concentrate in border regions. Economic theory alone allows only very vague conclusions about the spatial effects of integration. Depending on specific circumstances, border regions might benefit, lose or not be affected by integration. Empirical research on border regions – undertaken so far - does not allow to draw clearcut conclusions as well. At present, there is neither a direct test for integration effects in border regions, nor a comprehensive study on the development of border regions. To sum up, the survey suggests that rigorous theoretical and empirical analysis is needed to foster the understanding of integration effects in border regions. Grenzregionen und Grenzeffekte ziehen in der politischen Praxis und in der wirtschaftswissenschaftlichen Forschung gegenwärtig großes Interesse auf sich. Ursächlich hierfür ist die Vermutung, dass die besondere geografische Lage von Grenzregionen spezifische ökonomische Integrationseffekte bedingt. Dieser Überblick fasst die Ergebnisse der ökonomischen Theorie und empirischer Untersuchungen zu dieser Fragestellung zusammen. Es ist festzustellen, dass die ökonomische Theorie keine eindeutigen Schlussfolgerungen erlaubt. Ob Grenzregionen von Integration profitieren, negativ beeinflusst werden oder unberührt bleiben, hängt von den konkreten Gegebenheiten ab. Auch die vorliegenden empirischen Studien zu Grenzregionen gelangen zu keinen eindeutigen Resultaten. Bisher gibt es allerdings weder eine direkte Überprüfung der Integrationseffekte in Grenzregionen noch umfassende Untersuchungen der wirtschaftlichen Entwicklung von Grenzregionen. Insgesamt zeigt dieser Überblick, dass weitergehende theoretische und empirische Untersuchungen erforderlich sind, um fundierte Kenntnisse über Integrationseffekte in Grenzregionen zu erlangen.