Recent Submissions

  • Changing the landscape of psoriasis management : Value-based healthcare in psoriasis

    Hilhorst, Niels (2023)
    The healthcare sector is under immense financial pressure, and many acknowledge that a dramatic shift is required as the current system is not sustainable. Worrisomely, an increase in healthcare spendings does not necessarily seem to equate to better health outcomes or quality of care. Several solutions have been proposed to tackle this issue of which the conceptual framework known as value-based healthcare (VBHC) is further explored in this dissertation for psoriasis. The VBHC framework is formulated on the premise that the healthcare sector should deliver integrated care and strive to maximize the value created – improving quality and performance of care whilst simultaneously using resources in a sustainable and transparent way. Value in this context is defined as the patient-relevant health outcomes achieved divided by the costs needed to achieve these outcomes. Psoriasis is a common chronic inflammatory skin disease that is associated with a high multidimensional disease burden. It is associated with numerous comorbidities and is known to reduce quality of life (QoL) and life expectancy. In recent years major advancements have been made in the treatment of psoriasis and currently a range of treatments is available that can help manage the disease. Despite the substantial burden of psoriasis, nontreatment and undertreatment remain common. Additionally, widespread treatment dissatisfaction exists among persons with psoriasis. The costs associated with managing psoriasis and its comorbidities present a substantial economic burden to the patient and to society. Considering these facts, psoriasis management could benefit from VBHC’s holistic approach. However, the potential of VBHC in dermatology has yet to be fully explored as the concept is relatively new to the field of dermatology and has only been sporadically described in dermatologic literature.
  • Fostering flexibility in distribution networks through empirical studies, regulatory analyses, and mathematical programs

    Beckstedde, Ellen (2023)
    The rise of congestion issues in European distribution grids due to the rapid uptake of distributed energy resources highlights the need for advancements in distribution network operation and planning. Recognizing this need, the Clean Energy Package introduced several provisions to support distribution system operators in leveraging the potential of the flexibility that is increasingly present in their networks. In this context, the main objective of this dissertation is to gain scientific knowledge and empirical information to foster the use of flexibility in distribution networks through empirical studies, regulatory analyses and mathematical programs. More specifically, the following three topics are covered: developments in distribution network planning, practical experiences with flexibility tools, and open issues when designing flexibility markets. The first part of this dissertation examines developments in distribution network planning and finds that currently, no single approach exists across European distribution system operators. Furthermore, the level of transparency and developing a robust methodology for flexibility remain open issues in distribution network planning. The second part explores the regulatory toolbox for flexibility and examines practical implementations of dynamic distribution network tariffs and flexible connection agreements. While incentives for efficient network usage are being integrated into both flexibility tools, open questions remain regarding the optimal design and compatibility of these tools. In this context, regulatory sandboxes can be an important regulatory instrument. The outcomes of existing sandbox projects reinforce the idea that regulatory sandboxes can be an effective instrument for examine innovations, such as flexibility, in a real environment. However, this potential can only be achieved when effectively implementing the administration, derogations, application process and reporting within sandbox frameworks. The third part qualitatively discusses open issues regarding the use cases, incentives, operational timeframes, rules and products, and roles and responsibilities in flexibility markets. Furthermore, a bilevel model was developed to evaluate strategic behavior in these markets. The derived characteristics of the price-setter and inc-dec games using flexibility and redispatch markets can be used to support regulators and system operators in detecting these games. Finally, a comparison of wind curtailment and imbalance data revealed that the counterbalancing costs associated with flexibility procurement can be significant, depending on the system's imbalance position. The influence of these counterbalancing costs on the use of flexibility in network planning was illustrated using a bilevel model and a stylized test case.
  • Text analytics to study interfirm contracts; Text analytics to study interfirm contracts

    Distelmans, Tineke (2023)
    In today's highly competitive environment, innovation has become crucial for a firm's survival. Therefore, many firms rely on collaborations with external partners for their R&D activities. This dissertation demonstrates the use of text analytics in studying such interfirm (R&D) contracts. In Chapter 1 introduces the use of correlated topic modelling (CTM) algorithm to uncover the contextual richness and framing of contractual clauses. Chapter 2 zooms in on a specific contextual factor, technology maturity, and examines its impact on contract design and the framing of clauses. The final chapter delves into how partner experience influences language customization in contracts. Overall, the findings emphasize the rich dimensionality of contractual language and the significance of textual analysis techniques in unraveling the complexities of interfirm contractual language.
  • The impact of ownership traits on acquisition behavior and performance

    Spolverato, Gianni (2023)
    Context This doctoral thesis delves into examining ownership traits and their impact on corporate acquisition behavior, with a primary emphasis on family-owned and private equity-owned firms. The research investigates the decision-making process of these block holders when investing in firms, particularly the dilemma they face in choosing between monitoring efforts to maximize shareholder value and pursuing private motives. The studies build on the determining factors that influence each type of owner's inclination towards value maximization, considering their unique identity, correlated private motives, and the relative significance of these motives compared to potential financial gains they might forego in pursuing private benefits. Aim To investigate how shareholder identity affects the acquisition behavior and performance of firms. Studies Chapter one explores how private family firms select their targets, focusing on diversification, internationalization, and innovation in their acquisition strategies. Using Behavioral Agency Theory, the study argues that these firms tend to prioritize social and emotional wealth (SEW) over purely financial gains. The paper hypothesizes that this tendency leads family firms to approach target selection cautiously, for instance, leading towards an aversion to acquiring highly innovative or cross-border targets. In chapter two, the focus shifts to the influence of private equity (PE) investors on publicly listed firms, particularly in the context of Mergers & Acquisitions (M&A). The chapter suggests that the motivation to create value through M&A decisions depends on whether the PE firm's investment occurs before or after the firm's initial public offering (IPO). Chapter three addresses the agency cost associated with surplus capital in the PE industry and its implications for buy-and-build strategies. As the industry accumulates an increasing pool of unallocated capital, PE firms face mounting pressure to deploy it judiciously. The study contends that implementing buy-and-build strategies, which involve making add-on acquisitions in portfolio companies, can effectively channel excessive levels of unutilized capital. Findings The first chapter underscores that family-owned firms prioritize SEW over financial gains in target selection for acquisitions, resulting in a conservative approach. This preference is particularly pronounced when led by family CEOs and founders. In the second chapter, the study reveals that post-IPO PE investors enhance M&A performance, especially with greater board representation. In contrast, pre-IPO investors are associated with lower returns, particularly when they exert stronger board influence and the firm's stock liquidity is lower. Finally, the third chapter addresses the pressure faced by PE firms to efficiently deploy surplus capital, introducing the buy-and-build strategy as a response. It finds that this pressure can lead to more investments in add-on acquisitions and a larger propensity for those deals to be unrelated to the platform's core industry. Moreover, buyout returns tend to be lower for buyout targets owned by pressured PE firms.
  • In-depth examination of early contracting practices of founding teams

    Subotic, Marjana (2023)
    One of the earliest decisions founders are faced with is how to split the equity in their team. Assessing each founder’s past and future contributions is difficult to evaluate given both the venture’s and founders’ future is inherently uncertain. New competitors may arise and business models may change, potentially requiring a different skill set than those the founders possess. Founders may also lose their passion for the venture, encounter a new, more exciting opportunity, face health or family-related problems or may run into conflict with their co-founders, which might provoke their exit from the venture. The goal of the doctoral dissertation is to dive deeper into dynamic equity agreements and examine both their antecedents and consequences, while the question if inclusion of such provisions in the end would be good for the venture team and firm performance remains to be addressed. Apart from the crucial role of formal agreements among founders’ dynamics, early-stage growth will also be associated with differential role emergence among founding team members in terms of work specialization and differential allocation of responsibilities. For instance, during early stage growth, some founders will find themselves being more oriented towards stakeholder management, financial, marketing or human resource issues. Together, this doctoral study would not only contribute to the academic literature on the earliest decisions founders have to take related to their contracts and roles, but would also have important practical implications concerning what agreements founders are best of making from the outset of their ventures. Uncertainty regarding both founding team- and venture-specific factors may matter for our understanding of the adoption of dynamic equity agreements.
  • Assessing renewable gas policies using a long-term equilibrium energy system model

    Roach, Martin (2023)
    The European Union’s ambition to be climate neutral by 2050 implies an unprecedented transformation of the energy system to substantially reduce the use of fossil energy sources. Economists have identified several potential simultaneous market imperfections – market failures, policy failures, and political economy constraints – to consider that may provide an economic rationale for introducing several climate and energy related policies. Market failures in electricity markets are widely studied in academic literature. Still, insufficient attention has been given to describe potential market failures in a future decarbonized energy system characterized by increased sector coupling and renewable gas technologies. This dissertation assesses renewable gas policies using economic analysis to substantiate the presence of a market failure or evaluate either the costs or benefits of market interventions in response to a market failure, thereby highlighting the need for or impact of second-best solutions. In each chapter of this dissertation, we apply a stylized numerical case study to simulate an energy system using techno-economic input data and inform the policy assessment.
  • Cost variability in medical treatments: A value-based healthcare perspective

    Roman, Erin (2023)
    This comprehensive thesis is dedicated to the crucial topic of cost transparency within the healthcare sector, with a primary focus on its significance in achieving the goals of value-based healthcare (VBHC). The research is structured into five studies, each addressing specific research objectives and significantly contributing to healthcare management. Paper 1 conducts an extensive systematic literature review that delves into the complex cost variability in healthcare settings. This review identifies and categorizes various cost drivers across different medical domains. It presents a comprehensive overview of the factors contributing to cost variations and offers valuable recommendations for future research regarding variables to investigate and methodologies to employ. This chapter significantly enhances our understanding of the intricacies of cost variability in healthcare, paving the way for more informed decisions and practices. Paper 2 takes a deep dive into early-stage invasive breast cancer treatment costs. Employing the innovative approach of time-driven activity-based costing (TD-ABC), this chapter aims to unravel the specific drivers of cost variability within this medical domain. By analyzing factors such as patient characteristics and disease severity, this research provides essential insights into the dynamics of treatment cost determinants. These findings are critical for optimizing care delivery and resource allocation. Paper 3 narrows its scope to the field of dermatology care, specifically concentrating on the consultation component of psoriasis treatment. Utilizing TD-ABC, this chapter identifies and explores key cost drivers, including patient status, personality type, and therapy switches. The empirical analysis sheds light on the factors contributing to cost variability and offers actionable recommendations for process improvements within dermatology departments. Paper 4 builds upon the foundational research initiated in Paper 2, specifically focusing on the luminal B molecular subtype of breast cancer. This chapter uses statistical analysis to examine a broader dataset, providing insights into the cost drivers for the entire treatment cycle and the surgical intervention within this treatment pathway. These findings are essential for optimizing care and exploring potential applications of bundled payments in the context of breast cancer treatment. Paper 5 focuses on bundled payments, a prominent reimbursement approach within VBHC. This chapter conducts a scoping literature review to compare the existing body of research on bundled payments with the theoretical framework proposed by Porter and Kaplan. This analysis uncovers significant gaps and challenges in implementing bundled payments, highlighting the need for further exploration and standardization. In summary, this thesis comprehensively explores cost transparency in healthcare and its implications for achieving value-based healthcare. By systematically addressing critical gaps in the existing literature and providing practical insights, this research seeks to empower healthcare providers and policymakers to enhance the efficiency and value of healthcare delivery, ultimately benefitting patients and the entire healthcare ecosystem.
  • Being (like) a leader. Essays on the effects of leaser identity through a social identity lens

    Desmet, Lien (2023)
    Although research on leader identity has been ongoing for twenty years, there are still considerable gaps in the literature, in particular related to its potential drawbacks. This dissertation employs social identity theory to examine the effects of having or lacking a leader identity on managers, non-managers, and their surroundings. While our research strengthens existing research on the benefits of having a leader identity, it also presents an argument for a more nuanced approach, acknowledging that having a leader identity may also lead to unwanted outcomes. These findings not only enhance our understanding of leader identity but also contribute to the broader leadership and organizational behavior literatures, including research streams on leadership behavior, performance, well-being and impression management.
  • The market access of complementary diagnostics, precision medicine reimbursement policies and value assessment

    Govaerts, Laurenz (2021)
    Precision medicine relies on two technologies jointly working together to deliver benefit to patients, a medicine on the one hand and a diagnostic on the other. The diagnostic's purpose is to identify the right patient population for the medicine, and could be considered complementary to the use of the medicine. In recent years the market access of these complementary diagnostics has been scrutinized as being inadequate to ensure time access for patients. This thesis has delved into this issue and, as indicated in Chapters 1 and 2, sought to gain insights in these market access hurdles and gain a better understanding of the value derived from complementary diagnostics for our healthcare system. Chapter 3 delves into the reimbursement policies of complementary diagnostics (such as companion diagnostics). It identifies the reasons why the reimbursement issues of complementary diagnostics, and specifically companion diagnostics have emerged across European countries. In this study several issues with the standard in vitro diagnostic reimbursement pathways were identified across eight European countries, that consequently have risen to prominence when precision medicine was gradually introduced into healthcare systems. Several alternative reimbursement approaches were identified, specifically for companion diagnostics in Germany and Belgium and more broadly for complementary diagnostics in France. Chapter 4 examines the Belgian healthcare payer's health technology assessment of precision medicines with companion diagnostics. This research formulated several recommendations that could enhance the assessment practice under the novel reimbursement pathway for precision medicines with companion diagnostics in Belgium, as identified and discussed in chapter 3. Specifically, the introduction of the linked-evidence approach was recommended to be introduced in the assessment practice as many companion diagnostics lack the necessary direct evidence to establish their clinical utility. In Chapter 5, a study on the interaction between the biomarker that is identified by the diagnostic test, and the precision medicine is discussed. This interaction can also be referred to as the 'precision mechanism'. In this chapter we introduce the use of a novel performance parameter that examines directly what is at the heart of precision medicine; The ability of the diagnostic test to identify patients who are more likely to respond to treatment. These novel parameters convey the probability that a patient belonging to a specific subgroup will benefit from precision therapy or not. We applied these novel parameters to European medicine agency's approved precision medicines. The result of this analysis shows that not every companion diagnostics, or therefore precision mechanism, provides the same clinical utility, and that this differentiation could inform reimbursement decision making. Chapter 6 covers a systematic review on the use and adoption of assessment frameworks for complementary diagnostics such as omics technologies, by health technology assessment agencies. Many of these frameworks have been published, however none have seen their wide scale adoption by health technology assessment agencies. When looking at the health technology assessment reports on these technologies, the most recurrent elements under assessment were the clinical utility and the cost-effectiveness of these types of tests. Concepts such as ethical, social, and organisational aspect were often not considered. Specifically for organisational aspects, this could be of concern, as the specific context in which a test is implemented determines its clinical utility and therefore its cost-effectiveness. In Chapter 7 this issue is further illustrated. The working hypothesis of the study is that specific contextual factors influencing the clinical utility of a test (e.g., level of training by the treating physician, local clinical guidelines, experience level, etc) will therefore influence the cost-effectiveness, and hence the value perception of the test, which is expressed through the value-based price at a certain willingness to pay threshold. The study collected a range of published clinical utility scenarios across countries and healthcare systems. These scenarios were consequently inputted into a cost-effectiveness model with all other variables kept the same. The results showed that there is a range of outcomes where either the test can be seen as extremely valuable to the current clinical practice and others where the test adds not much additional benefit tot the current practice. This finding has its implications if one is to consider value-based pricing mechanisms as a pricing methodology for complementary diagnostics. In summary, this work took a closer look at the policies forming the market access of complementary diagnostics together with a specific focus on their clinical utility, how it is established, how it can be interpretated through probabilistic performance parameters, how its interpretation has implications for reimbursement policies and finally how contextual factors determining the clinical utility influence the value perception of these tests.
  • Strategic decision making in entrepreneurial firms: A coalitional view

    Bourgois, Dries (2021)
    When entrepreneurs are asked about their ventures’ estimated chances of growth and survival, they typically tend to be much more optimistic than what statistics would suggest. Both theory and empirical evidence support this view of entrepreneurs being unduly positive about their future venture prospects. Entrepreneurs create forecasts for making a wide variety of decisions such as sales and financing decisions. Errors or positive biases in these forecasts have been shown to substantially decrease venture performance. Far less attention, however, has been spent on how such errors affect important external stakeholders. In this project we focus on one particularly relevant stakeholder for entrepreneurial ventures, being their venture capital (VC) investors. VCs are one of the earliest resource providers to entrepreneurial ventures. Moreover, entrepreneurs’ forecasts about the future venture performance are what VCs rely on to inform their decisionmaking, both prior to and after the investment has been made. Given the importance of forecasts and the accuracy therein to VCs, this project will examine (1) when entrepreneurs provide more positively biased forecasts to their VCs and (2) how VCs react to positive bias in VC-backed ventures.
  • Linguistic cues in online product reviews

    He, Xzavier (2022)
    Online product reviews ("reviews" hereafter) are prevalent and valuable. Because of that, a large stream of research in marketing investigated reviews under the following three main topics: 1) the role of review writers, 2) the role of review readers, and 3) the role of linguistic cues in reviews. This dissertation further builds on this stream and proposes three new angles that were under-researched. Specifically, we compose three essays that focus on 1) the intents of review writers to write a review based on linguistic cues and their impact on perceived review helpfulness, 2) the effect of humanlike linguistic cues on perceived review helpfulness, and 3) the usage of emotional intent based on linguistic cues in fake reviews and its impact on review trustworthiness. All three essays are structured under the same pattern to use linguistic cues as a tool to provide a unique solution for the related issues in reviews from both writers' and readers' perspectives.
  • A constitutive view on entrepreneurship through acquisition : Towards a conceptual framework

    Vanoorbeek, Hans (2022)
    The purpose of the thesis is to analyze the phenomenon of “Entrepreneurship through Acquisition” or ETA. An ETA transaction as opposed to a buyout is defined here as a smaller and more entrepreneurial version of the classical leveraged management buy-in. Previous research on entrepreneurship and transitions into entrepreneurship, have always been predominantly focused on start-up entrepreneurship. ETA is a relatively widespread phenomenon and an alternative way to become an entrepreneur. The main focus here lays onthe study of the middle-aged senior (nascent) ETA entrepreneur. Besides making a typology of the nascent and actual ETA entrepreneur, the influence of different forms of entrepreneurial capital and the likelihood of ETA entrepreneurial entry has been analyzed in the first part of the thesis. While work and/or managerial experience, prior start-up or shareholdings and parental background do not have a significant impact on the likelihood of becoming an ETA entrepreneur, self employment, the higher the amount an ETA entrepreneur is prepared to invest and a certain age do increase the odds of acquiring a company. A second part of the thesis analyzes the investment criteria of an ETA manager, while comparing them between nascent and actual ETA managers and comparing them with the IC of other types o similar investors like private equity (LBO and MBI), venture capital, business angels and search funds. The latter and the MBI investors being the most similar. “Potential market growth”, “professionalization and improvement potential”, as well as “stable demand and recurring customers” were found to be the three most important investment criteria, showing little differences, except for “location” and “technology”, between the nascent and actual ETA entrepreneur. Three criteria, i.e. “potential market growth”, “technology” and “sales turnover” have the strongest significant influence on whether a company finally gets acquired or not. A third part of the thesis measures the social identities of the (nascent) ETA entrepreneurs and their impact on the nascent-active gap. Using the framework of Fauchart & Gruberfor founder identities measured by the scale developed by Sieger et al., the Darwinian founder social identity is the predominant social identity of the (nascent) ETA entrepreneur. On the other hand, no significant relationships between one of the social identities and the likelihood to actually become an active ETA entrepreneur in a given time period compared to when they do not have this identity, were found.
  • Value and Marketability - Determinants of the discount for lack of marketability

    Van den Cruijce, Johan (2022)
    The valuation of private companies is a matter of interest for many stakeholders, including valuation professionals, auditors, courts, and tax authorities. The matter is deceptively complex, notably because there is no consensus on the nature, size, and determinants of the so-called discount for lack of marketability (DLOM). The DLOM can be defined as an amount or percentage deducted from the value of an ownership interest to reflect the relative absence of marketability. Indeed, most valuation methods lead to value indications for a marketable interest, and it is generally accepted that investors attach a lower price to assets that are not readily marketable. The DLOM is oftentimes oversimplified as the difference in value between an illiquid (unlisted) stock and an all-else-equal liquid (listed) security. This value gap is important but ill understood. Leading scholars have noted time and time again that fair market value calculations often boil down to taking a marketable value estimate and reducing that amount by a contrived percentage. In practice, DLOMs of 20% to 40% are routinely used for valuing private businesses. The extant literature has proposed various DLOM estimation methods that fall into two broad categories: theoretical and empirical models. All of these models have been challenged, either because they require the input of information that cannot be objectively determined for private companies (theoretical models), or because estimates based on the comparisons between liquid and illiquid valuation subjects are by nature always imperfect and thus prone to discussion (empirical models). Nevertheless, and in the absence of better information, the empirical models, especially, have received lots of attention and the averages presented in these studies are often used in practice without much formal reasoning or economic justification. In order to shed more light on the determinants of the DLOM we have turned to an alternative source of information that can bring additional insights. Specifically, we have turned to court decisions that decide on private company valuations, including the DLOM to be applied. The court typically justifies its decision by referring to how the specific company is situated, and the rights and obligations attached to the valuation subject. This contextual information provides more background than the pure financial information that can be found in traditional data sources. This method which combines elements of qualitative and quantitative analysis has allowed us to demonstrate that the company’s ownership structure, its operations, the transfer restrictions on shares, the exit possibilities for shareholders, and the level of control attached to the valuation subject have a significant impact on the DLOM.
  • Essays in financial innovation and sustainability

    Kolokas, Dimitrios (2022)
    The scope of this dissertation is to observe three of the most prominent trends of this era and to present innovations that could inspire both academics and businesses. There is an urgent need to improve the traditional ways in which the markets operate to achieve financial growth while respecting the environment and the society. The third and fourth manuscript tackle directly the topic of sustainable development through the lenses of SMEs. The first manuscript offers evidence related to the development of FinTech entrepreneurship in a market. Through FinTech and sustainability might appear unrelated at first, their simultaneous development could support achievement of a sustainable economy. FinTech could foster the availability of green finance, which is necessary to the capital-intensive sustainability transformation (Vergara and Agudo, 2021). FinTech supports the sustainable development not only through green finance but also by providing financial resources to underrepresented groups, hence promoting financial inclusion (Arnert et al., 2020). Both FinTech and sustainability are relatively recent trends, hence this dissertation, which focuses on financial innovation and sustainability, oughts to provide evidence for both considering their increasing dependency and relevance.

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