The 2006 health care reforms in the Netherlands were aimed at improving the affordability, accessibility, and quality of health care, as well as freedom in health care. However, the reality is that since the reforms (which include the privatisation of health-care insurance), costs have further increased and accessibility has decreased while freedom of choice has declined. The reforms reduced freedom, while increasing costs and reducing accessibility. The aim of this thesis is to investigate whether these issues stem from a deeper (Utilitarian) philosophical foundation of how health care is currently funded and to propose a mode of funding founded on Aristotelian principles that would be in support of freedom without adversely affecting (or even improving) costs, accessibility and quality The analysis of the system of Managed Care (in Chapter 2) and its implementation in The Netherlands (in Chapter 3) suggests that the rising costs of health care may be related at least in part to the utilitarian foundation of this system (with its utility-maximising consumer and its profit-maximising producer who, in an oligopoly like the health-care market, is able to generate super-normal profits), in part to the heavy administrative load associated with Managed Care, and in part due to contracting practices. All of which also restricts freedom of choice. Aristotle's ethics, specifically his extit{Nicomachean Ethics}, underlines the importance of freedom (of deliberation) as the quintessential requirement for eudaimonia. If this were taken as the philosophical foundation for the health care system, then patients and health care providers would be able to make informed choices that align with their personal goals and values. This freedom of deliberation stands in stark contrast with protocolisation, standardisation and homogenisation that Managed Care brings. Such a system creates a 'monoculture' in which it is difficult to find discernible differences in price and quality, making it equally difficult to identify possible trade-offs between the two and implications of such trade-offs. In Chapter 4 I propose a mode of funding Dutch health care that safeguards freedom of deliberation in health care that would be in line with the Dutch socio-economical environment and political system. The proposed Health Care system is a universal health care system with a single-payer that covers all health care expenses; where medical decision/treatments are made autonomously by client and practitioner without meddling/pressure/ruling by other parties who are not practising health care; where the funding of health care is a matter of transparent deliberation between all parties and a part of political discourse. By prioritising freedom of deliberation, the proposed reforms address the limitations of Managed Care's utilitarian philosophy and offers a more human-centred approach to health care. A system that is based on Aristotelian philosophy creates an environment that encourages open and honest communication between all parties involved and is expected to improve all relevant aspects of the Dutch health care system and health itself. The suggested reforms are far reaching and may seem unrealistic. Its proper functioning would indeed require substantial social reform in all spheres of social life (economic, legal-political, and cultural), though they remain entirely in-line with Dutch socio-econo-political reality. In conclusion, this thesis argues that the Netherlands' health care reform should prioritise freedom of deliberation (the fundamental requirement for eudaimonia). As such individuals' well-being and values are prioritised, which is expected to have beneficial effects including reducing costs and improving the overall quality of care without diminishing access to it. Free deliberation and subsequent cooperation are thought to have more potential than competition.

The thesis proposes an education system that have the potential to safeguard freedom of education. Freedom of education is found to be essential for human flourishing after discussing Aristotle's Eudaimonia and different definitions of freedom. The thesis proposes that the social spheres (cultural, economic, and political) need to have an ideal allocation of freedoms: negative freedom in the cultural sphere, positive freedom in the economic sphere, and Enlightenment freedom in the political sphere. This ideal allocation of freedoms is compared to the current allocation which is derived from a broad review of educational reforms in the United States of America and the Netherlands. Ultimately, the proposed system is based of a voucher system that ensure equal funds to students regardless of the curriculum they choose. Such a system also provides complete educational autonomy for the teachers to create their own curriculum, or choose which ones to participate, and define their own quality standards outside of political and economic influences.

The recommendations in this thesis are relevant for research and consultancy firms specialized in social aspects of technology. The problem that is analyzed is how in the future society can remain inclusive, when faced with the problems of technological innovation and the possibility of it causing technological unemployment. Researching such societal problems is the goal of this thesis, and the results may be interesting for those (for example in consultancy firms) who seek to widen the concept of "inclusive society", by including ideas of what meaningful participation and individual autonomy could entail. For example, in the third model of inclusive society, maintaining individual autonomy includes providing civil society with true freedom for self-development. The discussion of how individual autonomy in this sense could be maintained, is closely related to the way work is funded, and how productivity gains in the economy are distributed to finance more work.

Our planet is witnessing an unprecedented increase in temperature that is causing frequent damages such as extreme weather conditions, acidification of oceans and extinction of species that may soon become irreparable. Various studies have reported that greenhouse gas emissions (GHG) from human activities in industries that produce 'material goods' like transportation, energy, manufacturing and agriculture have been the chief drivers of the climate change crisis. Even as greener and renewable energy technologies are increasingly being adopted, since consumption of material goods in the rich parts of the world continue to increase, it may not be enough to solve the environmental problems in time. However, we may be able to solve them by adopting a different way of living. In order to do so, we need to understand the purpose of the economy. According to Aristotle, Eudaimonia or the 'good life’ which is the full development of human capabilities or virtues is the ultimate end of human life and the purpose of the economy or the production and consumption of material goods by people are simply a means towards this ultimate end. A similar idea that human beings have an ultimate end towards which all actions are directed can also be found with the more popularly known Maslow’s hierarchy of needs. This essentially means that human beings need material wealth only insofar that it supports the fulfilment of their non-material needs: the development of capacities/virtues. 'Non-material' can refer to needs such as enjoying a classical dance performance, or studying philosophy or engaging in therapy. This perspective allows us to rethink growth in terms of a shift from material to non-material needs, which could also help solve the world's environmental problems as long as non-material needs can be met in less polluting ways (as compared to how material needs are met). Following this, economic activities are classified as physical (or goods-producing) or non-physical. Activities in the physical economy meet material needs and have a higher potential for productivity growth. Activities in the non-physical economy, including health care, education, research and arts, meet non-material needs and have a lower potential for productivity growth since human work is generally the final output. Based on this classification, it is observed that, in the advanced economies, the share of the physical economy in total demand is getting smaller, while the share of the non-physical economy is getting bigger over time, reflecting human development from material to non-material growth. If the non-physical economy − which consists mainly of human work such as a doctor's advice, a lesson, a concert − is relatively less polluting, such a shift could mean good news for the environment. While this looks promising, a consequence of the lower potential for productivity growth in the non-physical economy is that their activities can be expensive. Baumol (1993), termed this the 'cost disease' and argued that people in the rich parts of the world can afford the expensive 'personal services' when funds resulting from the productivity gains in the physical economy (due to labour-saving innovations) are transferred to the non-physical economy. Yet, nowadays, the standard response to the 'cost disease' is to replace human work with technology through standardisation, computerisation and robotisation of hitherto human tasks as a way to minimise costs. Due to the nature of work in the non-physical economy, the growing technology/ material-intensity can affect the quality of the non-material value created, while it may also increase the pressure on the environment. This led me to investigate the impact of the rising technology-intensity in the non-physical economy on the quality of outcome and on the environment. One of the main activities in the non-physical economy, health care, is 'an art and a science' in the sense that it takes care of the health of a human being in order to enable him to develop intellectually and psychologically and it is not just about 'fixing' what is broken. Doctors, therapists and nurses are people who possess besides clinical knowledge, interpersonal skills such as understanding and empathy to carry out complex human interactions with patients. Yet, in recent times, especially in the United States, technologies such as electronic health records (EHR), e-prescribing, tele-medicine and health apps are increasingly being adopted to displace some of the creative work performed by health care professionals. The main drivers of such trends identified are: the privatisation of health care, the systems of 'Managed Care' and government measures such as the American Recovery and Reinvestment Act (ARRA) of 2009 that allocated funds to incorporate health information technologies in health care facilities across the country. Some of the common experiences found with the adoption of technology in health care are: a supplier-induced demand for drugs and medical technologies due to a 'fee-for-service' payment model for doctors, a 'technology arms race' between hospitals and ‘direct-to-consumer’ advertising of medicines and medical technologies. Some of the consequences of these trends found are: unnecessary testing leading to increased overall health care costs, 'physician deskilling' due to decreased clinical knowledge and psychological and health implications for patients due to less physician-patient interactions and more 'end-of-pipe' solutions. From a brief review, it is also found that the health care system in Canada is less technology-/material-intensive than the health care system in the U.S. with (roughly) the same quality of service which shows that different kinds of health care systems can coexist with one another. A second activity of the non-physical economy, education, is one that enhances the intellectual and spiritual development of students, guided by a curriculum. According to various studies, teachers are indispensable in this activity in terms of their personal knowledge, their pedagogical capacities and their ability to instill curiosity, enthusiasm, sympathy, and morality in students through complex and dynamic interactions. Yet, similar to health care, even the creative work of teachers are being displaced with Information and Communication Technologies (ICT) such as: talent management software, digital learning technologies, MOOCs, allegedly to improve quality of education. In the United States, some of the trends commonly found to promote such technologies are: a pay-for-performance model for teachers to improve productivity of student grades, a common core standard curriculum and standardized tests for students to get them ready for college and careers. Some of the consequences of the growing technology intensity in education are found to be: teacher deskilling, lack of evidence of improved student performances and psychological implications for students such as diminished social skills, lack of creative and original thinking etc. These findings suggest that the growing technology-intensity in health care and education may have not significantly improved the quality of service provided, especially since the nature of work in these activities are different. Besides this, they could also lead to a higher environmental burden. In this thesis, I investigate whether the latter is the case, which is done in two steps. First, I investigate whether the non-physical economy is less polluting than the physical economy. Next, I examine the environmental consequences of the rising technology-intensity of the non-physical economy. The empirical research method applied is the Environmentally Extended Input-Output (EE-IO) analysis, which is used to compute the direct and indirect environmental effects of the physical and the non-physical economy. Direct effects refer to the pollution recorded at the place where it arises (for example, emissions due to health care). Indirect effects refer to the pollution caused by industries that supply inputs to health care, and for which the health care sector (as sector of use) is (indirectly) responsible. Through an EE-IO analysis, environmental effects (such as emissions) are ascribed to the sector of use, by reallocating emissions from the sector where they originate (sector of origin) to the sector that uses the goods or services supplied by this sector. The EE-IO analysis makes use of an Input-Output (I-O) table which records intermediate deliveries of goods and services between sectors in an economy, as well as each sector's deliveries to final demand. In addition, it uses the environmental accounts of each sector to compute the total emissions for which a sector can be held responsible, which consist of its own (direct) emissions plus the emissions that are related to the inputs it purchases from other industries. The two equations that guide this computation are B=b*(1-A)¯¹ and E=B*f where B= a vector of total (direct+indirect) emission intensities (per sector); b=direct emission intensity vector; (1-A)¯¹= the 'Leontief Inverse matrix' (derived from an I-O table) that represents the technical coefficients or the total (direct+indirect) inputs required per unit of a sector's output; f=final demand and E=a vector of total (direct + indirect) emissions per sector for a given level of final demand f. The results found were that the non-physical economy in the United States is less polluting in terms of global warming and acidification potential, energy use and tropospheric ozone gas emissions, even if emissions are re-allocated from sector of origin to sector of use. This result suggests that the impact on the environment will be lower if human beings become increasingly interested in non-material rather than material growth. However, this result may not come about if the non-physical economy gets more technology-intensive. To empirically investigate the increase in technology-intensity in health care and its corresponding environmental burden, two comparative studies based on the EE-IO analysis were carried out. The first one compared the health care system in the United States between 1995 and 2015. After adjusting both I-O tables for inflation (using Miller & Blair’s (2009) "double deflation" method) and regrouping them for comparable sector classifications, it is shown that the health care sector's technical (Leontief inverse) coefficients increased for 'computer, electronic & optical equipment', 'post & telecommunications', 'electricity & water supply', and 'renting & other business services' − indicating that the technology- or material-intensity (in terms of medical technology, ICT, administrative technology) as well as the electricity-intensity of health care increased from 1995 to 2015. Although the use of 'chemicals & pharmaceutical products' in the health care sector itself decreased, final demand for chemicals & pharmaceuticals per capita almost doubled between 1995 and 2015. In sum, the results found showed that technology/material-intensity in terms of ICT, medical technologies, energy use per unit of output and medicines per capita increased from 1995 to 2015. These data support, or at least do not falsify, the hypothesis of a trend towards higher technology-intensity of health care. However, the result for the environmental burden of the increased technology-intensity was found to be mixed. Firstly, total CO2 emission intensity of health care and the indirect contribution from 'post & telecommunications', 'computer, electronic & optical equipment' and 'renting & other business services' decreased from 1995 to 2015, largely due to an economy-wide switch to less carbon-intensive sources of energy. Although the shift from coal to natural gas reduced CO2 emissions, it also led to other types of environmental problems, such as those associated with increased production of shale gas. Secondly, the indirect emission contribution from 'electricity & water supply' industry to health care's carbon intensity increased due to the increase in energy use per unit of output (possibly due to increased use of medical equipment and other technologies in hospitals). This also led to higher total (direct+indirect) emissions from the health care sector in 2015 than in 1995 for the respective levels of final demand. Therefore, as long as the technology-intensity of health care keeps rising, this is likely to involve rising pressure on the environment (not only in terms of emissions but also in terms of increased use of earth's finite resources). The second study compared the health care system in the United States with the health care system in Canada for the year 2014. The results showed that the U.S. health care sector's technical coefficients were higher than those of Canada's health care for the relevant sectors examined in the previous study. This shows that U.S. health care is more technology-/ material-intensive in terms of medicines, medical technology, ICT and administrative technology than Canada's health care while reliance on human work is lower. Next, the total (direct+indirect) carbon-intensity of U.S. health care was also found to be higher than that of Canada's health care. This is mainly because the indirect emission contribution from sectors, namely, 'chemical & pharmaceuticals', 'renting & other business services', 'electricity & water supply' 'computer programming & information services' to health care are higher in the U.S.. However, the indirect emission contribution from sectors 'telecommunications' and 'computer, electronic & optical products' are found to be lower in the U.S. (in spite of a higher use of their goods per unit of output), possibly due to a lower carbon-intensity of these two sectors in the U.S. than in Canada. All in all, the important insight from these two studies is that even though increased purchase of medicines, ICT and related medical & administrative technologies by health care activities in the U.S. between 1995 and 2015 has not led to higher total CO2 emission intensity of health care, we know that as of 2014, high-tech health care in the U.S. is still more polluting than Canada's health care. This supports the argument that replacement of human work with technological solutions in the non-physical economy may lead to a higher environmental burden. In conclusion, since there is lack of conclusive evidence that the promotion of general, country-wide transition to high-tech health care (or education and arts) reduces costs while improving quality and reducing environmental burden, it may be desirable that free choice of technology in the non-physical economy is encouraged. The resulting diversity, or mix of low-tech and high-tech approaches in health care, education, arts, etc. would be less polluting than a linear high-tech approach in the non-physical economy, while leaving providers as well as recipients of services in the non-physical economy free to explore different technological paths.

This thesis is for Entrepreneurs, Managers, and Customers who are interested in paying Just Prices, and who would like to understand what the origin of the concept is, how it differs from the 'fair price', and how a Just Price could be reached in practice. This thesis is forward-looking rather than backward-looking. It will lead to recommendations for entrepreneurs and managers wishing to pay Just Prices, rather than to conclusions based on data regarding the past.

In this thesis I investigate possibilities for expanding freedom of choice in the development and use of digital education technologies. This thesis may be of interest to university policy-makers, students, professors, software-developers, or anyone interested in expanding freedom of choice in the development and use of digital education technologies. This research aims to investigate possibilities for the creation of a free space in the cultural sphere for digital education technology to protect from intervention by intellectual (near-) monopolies. Intellectual monopolies are companies that build their wealth by excessive monopolising access to knowledge and converting it into intellectual rents, a type of intangible assets. The thesis are examined against the background of an overarching perspective on society as consisting of three spheres. Legal-political sphere is to develop laws and regulations; Economic sphere is about production, distribution (trading) and consumption of goods; Cultural sphere is to generate idea and knowledge. In each sphere, there also are three aspects belonging to legal-politics, economics, and culture. The thesis consists of two parts and adopts a macro-to-micro research framework. In the first part, the research focuses on the macro-socialistic level first and then zooms in to business level (education technology) by analysing existing literature. This part investigates how intellectual monopolies emerge, first in general and then more specifically in digital education technology, and how they reduce freedom of education. More specifically, the thesis identifies economic, legal-political and cultural factors that promote intellectual monopoly in the digital industry, and explains how intellectual (near-)monopoly in digital education (e.g. in online-learning platforms, LMSs or video-conferencing software) arises as a consequence of particular relationships between the economic, legal-political and cultural sphere, where governments and international organisations give laws and regulation (e.g. IP law, education laws and regulation, the standardisation of education) that support the concentration of R&D in a few giant digital high-tech companies and the growth of (near-)monopoly positions in the digital education technology market, enabling high-tech giants to extract what in this study is called ‘learning-related rent’ (tangible and intangible assets formed by controlling learning tools and learning content), and reducing freedom of education (the core component of the cultural sphere). In the second part, the thesis zoom in further to the university level and examines the possibilities decision-makers at universities have to expand freedom of choice in digital education technology for professors and students through a case study of a Dutch university. An interview is conducted as the main method of the case study to collect data. From the interview results, legal-political, economic and cultural hurdles in establishing free space in choosing education technology in the cultural sphere have been identified.

The jobs of the world population are increasingly threatened in a world filled with constant technological improvements, and automation of tasks by machinery and artificial intelligence. Substitution of labour by machines is not only occurring in blue-collar jobs (usually uniformed workers working in eg. manufacturing) but increasingly also in white-collar jobs (usually ‘suit-and-tie’ workers working in offices). The more labour-saving technology is created and deployed, the more jobs are made obsolete, possibly leading to technological unemployment. This problem is likely to be aggravated by research and policies that are concerned with the so-called 'productivity paradox' or 'Solow-paradox', as well as the 'cost disease', and that seek to avoid or remedy both by increasing labour productivity across-the-board, that is, in 'personal services' such as education, health care, research, and the arts as well as in the goods-producing economy. If this were feasible, how could technological unemployment be avoided? Another option, explored in this thesis, is to take a fresh look at these phenomena, by asking whether they really are a 'disease' or 'paradox', or simply a consequence of a (harmless) natural structural change that is taking place in society, namely, the growth of 'personal services' relative to the physical (goods-producing) economy. Inspired by the writings of William Baumol (1993, 2012), this thesis explains that it will be possible to avoid dramatic increases in unemployment, if the productivity gains that are achieved in the technologically progressive sector (that implements labour-saving technologies) are used to fund the creation of new work in the technologically stagnant sector, the sector that tends to have a lower labour productivity growth compared to the technologically progressive sector. According to Baumol (1993, 2012), it is not possible or not desirable to increase labour productivity in the stagnant sector in the same way as this happens in the progressive sector by for example replacing human beings with software, machines, and AI. It may not be possible because of the nature of work in the stagnant sector compared to the progressive sector and it may not be desirable because the quality of services may decrease (Baumol & Wolff 1998). A case study involving the Netherlands and Germany, both of which are shown to suffer from the 'cost disease', was carried out to investigate whether the transfers of funds from the progressive to the stagnant sector is a realistic possibility. If resources are to be transferred from the progressive to the stagnant sector, the question arises how this could be realised. One possibility is investigated, namely, that governments implement profit taxation in the technologically progressive sector to collect the productivity gains in this sector and then use it to fund new work 7 in the technologically stagnant sector, including a public educational system. The conditions under which this solution is feasible was then investigated for the Netherlands and Germany, and concludes that Baumol’s (1993, 2012) solution to the cost disease could be realised if 50-70% of productivity gains in the progressive sector are used to fund work in the stagnant sector, and as long as the average wage rate in the stagnant sector is not consistently higher than the average wage rate in the progressive sector.

Out of all the events and phenomena surrounding the financial crisis of 2007/2008, one stood out: financialization. What is financialization, why does it occur, and is it problematic? It can be described as the financial sector increasing in size and importance relative to the real economy (including, for example, in terms of business practice and policy making) because of, amongst other reasons, redirected investments. When real economic growth slowed down, attention shifted to financial growth, often expressed in profit. According to several studies, this has led to rising inequality and economic instability. Its occurrence appears to be related to an emphasis on (Neoclassical) profit maximization. In recent times, this is expressed as shareholder value maximization, which became the goal of business activity. The emphasis is arguably unjustified, because theoretical assumptions on which the goal depends, including the presence of the Neoclassical perfectly competitive market, no longer hold in current real-world conditions (they appear more oligopolistic). Perhaps therefore, the prescription of profit maximization is no longer valid. Is the solution to try and return to perfect competition? Considering the aforementioned consequences, maybe it is time to visit other ideas too. The purpose of this thesis is to find elements of an economic model and especially a business model, that would provide a different economic goal. Ideally, a goal that, through our economic activities, would enable individuals to develop themselves and to participate in a stable economic system. Based on theoretical and empirical research, the thesis presents several building blocks for an alternative business model, relating to three realms of human existence: cultural-scientific, practical-economic and legal-political.1 From Aristotelian literature2 follows that eudaimonia would be the human goal (rather than Benthamite-utilitarian utility maximization).The cultural-scientific sphere would encompass what is referred to, by for example Wilken (1982) as, the Geistesleben. There would be freedom of thought, which contributes to development of, what Aristotle calls, virtues, which are essential towards eudaimonia. Financial literacy (Houghton Budd, 2017) might be instrumental. It would mean everyone would understand accounting and (also practice) bookkeeping in particular. An analogy with a mirror demonstrates that accounting shows what is happening. It is neutral yet it allows people to see what is going on, and thereby hold each other accountable. The practical-economic sphere would be devoted to fulfilling the material needs of people. It is important to note that this would not include limitless wants (which means the consumer is not insatiable). The underlying idea for economic activity would be the implementation of the ‘just price’3. A just price ensures that the costs of production are covered, but also, and this is an elaboration, the intellectual or spiritual input. The just price would be paid for the product of labour, and the input of the Geist of the producer. Labour would not be traded in a market because then remuneration might fall below that what is needed. Undeniably, the fact that there would be no labour market has huge implications.