In this article, we describe the emergence of a new Finance course in line with the concept of the Societal Cost-Benefit Analysis (SCBA). By means of an in-depth case study, we reconstruct the process of dissatisfaction and corresponding discussions among lecturers and students of the Master Integrated Care Design with regard to the learning aims and content of the Finance course, which is a study module of this master. During the period 2015-2021, the aims and content of this module were revised and remoulded several times in order to define a Finance course that was able to both sufficiently and creatively connect the domain of Integrated Care with that of Finance. In this process of reiterating revision both lectures and students played a crucial role. The ultimate result – the indicative Societal Cost-Benefit Analysis – was unexpected and unplanned, producing an outcome that surpassed the sum of its separate parts. In short, the process, as we describe in this case study, bears all the hallmarks of emergence. Moreover, the analysis shows how this process of emergence in combination with emergent leadership led to a practicable and encouraging outcome, which satisfied and committed all stakeholders, setting an example that is worth following.
Health and social well-being depend on many contextual facets which are interdependent in a complex way and are all but limited to the field of cure and care. Publications of the World Health Organization and the Dutch Ministry of Health show that good health also depends on socioeconomic aspects such as stable living conditions and (pre-emptive) debt counselling. Inspired by these findings, many programs have been launched that aim for an integrated approach of health and social issues. Although these programs enjoy a lot of sympathy, the implementation proves to be difficult. Among many obstacles, more than once the financing of the program is a stumbling block. The hesitation to invest is prompted by the uncertainties of the benefits these programs aim at. These uncertainties relate to both size and distribution. The intended results are mostly long term and not always easy to monetize. Moreover, the benefits may distribute among other stakeholders than those who bore the costs of the program, the so-called ‘wrong pocket problem’. To overcome the hesitation to invest, a social cost-benefit analysis offers a remedy. Social Cost-Benefit Analysis (SCBA): A SCBA assesses the impact of an investment on society by estimating all relevant costs and revenues – both financial and non-financial – and their (re)distributions amongst stakeholders. From this perspective, this type of analysis is an important contribution to policy development. Publications of public planning and research agencies in the Netherlands underline the contribution of SCBA’s to policymaking in the field of public health and social welfare.
Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n=90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were e 12,886 in BPR and e 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to e190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.
Due to the existing pressure for a more rational use of the water, many public managers and industries have to re-think/adapt their processes towards a more circular approach. Such pressure is even more critical in the Rio Doce region, Minas Gerais, due to the large environmental accident occurred in 2015. Cenibra (pulp mill) is an example of such industries due to the fact that it is situated in the river basin and that it has a water demanding process. The current proposal is meant as an academic and engineering study to propose possible solutions to decrease the total water consumption of the mill and, thus, decrease the total stress on the Rio Doce basin. The work will be divided in three working packages, namely: (i) evaluation (modelling) of the mill process and water balance (ii) application and operation of a pilot scale wastewater treatment plant (iii) analysis of the impacts caused by the improvement of the process. The second work package will also be conducted (in parallel) with a lab scale setup in The Netherlands to allow fast adjustments and broaden evaluation of the setup/process performance. The actions will focus on reducing the mill total water consumption in 20%.
INXCES will use and enhance innovative 3D terrain analysis and visualization technology coupled with state-of-the-art satellite remote sensing to develop cost-effective risk assessment tools for urban flooding, aquifer recharge, ground stability and subsidence. INXCES will develop quick scan tools that will help decision makers and other actors to improve the understanding of urban and peri-urban terrains and identify options for cost effective implementation of water management solutions that reduce the negative impacts of extreme events, maximize beneficial uses of rainwater and stormwater for small to intermediate events and provide long-term resilience in light of future climate changes. The INXCES approach optimizes the multiple benefits of urban ecosystems, thereby stimulating widespread implementation of nature-based solutions on the urban catchment scale.INXCES will develop new innovative technological methods for risk assessment and mitigation of extreme hydroclimatic events and optimization of urban water-dependent ecosystem services at the catchment level, for a spectrum of rainfall events. It is widely acknowledged that extreme events such as floods and droughts are an increasing challenge, particularly in urban areas. The frequency and intensity of floods and droughts pose challenges for economic and social development, negatively affecting the quality of life of urban populations. Prevention and mitigation of the consequences of hydroclimatic extreme events are dependent on the time scale. Floods are typically a consequence of intense rainfall events with short duration. In relation to prolonged droughts however, a much slower timescale needs to be considered, connected to groundwater level reductions, desiccation and negative consequences for growing conditions and potential ground – and building stability.INXCES will take a holistic spatial and temporal approach to the urban water balance at a catchment scale and perform technical-scientific research to assess, mitigate and build resilience in cities against extreme hydroclimatic events with nature-based solutions.INXCES will use and enhance innovative 3D terrain analysis and visualization technology coupled with state-of-the-art satellite remote sensing to develop cost-effective risk assessment tools for urban flooding, aquifer recharge, ground stability and subsidence. INXCES will develop quick scan tools that will help decision makers and other actors to improve the understanding of urban and peri-urban terrains and identify options for cost effective implementation of water management solutions that reduce the negative impacts of extreme events, maximize beneficial uses of rainwater and stormwater for small to intermediate events and provide long-term resilience in light of future climate changes. The INXCES approach optimizes the multiple benefits of urban ecosystems, thereby stimulating widespread implementation of nature-based solutions on the urban catchment scale.
Cycling booms in many Dutch cities. While smart cycling innovations promise to increase cycling’s modal share in the (peri-)urban transport system even further, little is understood of their impact or cost and benefit. The “Smart Cycling Futures (SCF)” program investigates how smart cycling innovations ─ including ICT-enabled cycling innovations, infrastructures, and social innovations like new business models ─ contribute to more resilient and liveable Dutch urban regions. Cycling innovations benefit urban regions in terms of accessibility, equality, health, liveability, and decreasing CO2-emissions when socially well embedded. To facilitate a transition to a sustainable future that respond to pressing issues, the SCF research project runs urban living labs in close collaboration with key stakeholders to develop transdisciplinary insights in the conditions needed for upscaling smart-cycling initiatives. Each living lab involving real-world experiments responds to the urgent challenges that urban regions and their stakeholders face today. The proposed research sub-programs focus on institutional dynamics, entrepreneurial strategies, governance and the socio-spatial conditions for smart cycling. Going beyond analysis, we also assess the economic, social, and spatial impacts of cycling on urban regions. The research program brings together four Dutch regions through academic institutions (three general and one applied-science universities); governmental authorities (urban and regional); and market players (innovative entrepreneurs). Together, they answer practice-based questions in a transdisciplinary and problem-oriented fashion. Research in the four regions generates both region-specific and universally applicable findings. Finally, SCF uses its strong research-practice network around cycling to co-create the research and run an outreach program.
