This dissertation looks into the role of discretion granted by EU directives in EU legislative decision-making and national transposition processes. It applies a qualitative single country-study,... Show moreThis dissertation looks into the role of discretion granted by EU directives in EU legislative decision-making and national transposition processes. It applies a qualitative single country-study, focusing on the transposition of six directives in the Netherlands, from the policy areas of consumer protection, environment and justice and home affairs (migration). In the theoretical part the concept of discretion is explored, using insights from both the legal and political sciences. The empirical analysis then presents both EU and national processes regarding the six directives, addressed individually as well as in a comparative manner. This study contributes to clarifying the reasons and circumstances regarding the granting of different margins of discretion to Member States and the effects of discretion on EU negotiations and national transposition. It confirms that discretion can have facilitating and impeding effects on transposition, explains why, and identifies other factors affecting transposition by interacting with discretion. Additionally, a more fine-grained approach to measuring discretion is proposed than hitherto. Finally, but addressed separately from the empirical analysis, the link between discretion and legitimacy is elaborated. It is argued that discretion in national transposition processes can be used to enhance the directives’ input, throughput and output legitimacy within national law. Show less
This thesis aimed to contribute to the optimal use of non-surgical treatment and timing of surgery among hip and knee OA and sciatica patients in two different ways. First, if guidelines are... Show moreThis thesis aimed to contribute to the optimal use of non-surgical treatment and timing of surgery among hip and knee OA and sciatica patients in two different ways. First, if guidelines are specific on non-surgical and (timing of) surgical treatment, the focus was on implementation strategies to improve guideline uptake in hip and knee OA and sciatica care. Across the different studies carried out in this thesis, knowledge, attitude of health care providers and organization of care seem to be relevant for any implementation of evidence based guideline recommendations in a multidisciplinary setting. Future implementation studies can start focusing on these topics. However, if guidelines are not available or not specific on e.g. optimal timing of total hip or knee arthroplasty (THA/TKA), additional evidence is needed. Therefore, the second part of this thesis focused on studying criteria and determinants to reach the best possible outcomes after THA and TKA, as information in the literature is lacking on optimal timing of surgery. Pooling multiple cohort studies in the Netherlands showed that preoperative status is the most important variable for outcome after both THA and TKA, i.e. patients with better preoperative quality of life, functioning and less pain had better postoperative outcomes. Show less
