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Objectives To generate insight into the differences between utility measures EuroQol 5D (EQ-5D), Health Utilities Index Mark II (HUI2) and Mark III (HUI3) and their impact on the incremental cost-effectiveness ratio (ICER) for hearing aid fitting Methods Persons with hearing complaints completed EQ-5D, HUI2 and HUI3 at baseline and, when applicable, after hearing aid fitting. Practicality, construct validity, agreement, responsiveness and impact on the ICER were examined. Results All measures had high completion rates. HUI3 was capable of discriminating between clinically distinctive groups. Utility scores (n = 315) for EQ-5D UK and Dutch tariff (0.83; 0.86), HUI2 (0.77) and HUI3 (0.61) were significantly different, agreement was low to moderate. Change after hearing aid fitting (n = 70) for HUI2 (0.07) and HUI3 (0.12) was statistically significant, unlike the EQ-5D UK (0.01) and Dutch (0.00) tariff. ICERs varied from e647,209/QALY for the EQ-5D Dutch tariff to e15,811/QALY for HUI3. Conclusion Utility scores, utility gain and ICERs heavily depend on the measure that is used to elicit them. This study indicates HUI3 as the instrument of first choice when measuring utility in a population with hearing complaints, but emphasizes the importance of a clear notion of what constitutes utility with regard to economic analyses.Keywords Hearing loss Á Costs and cost analysis Á Quality-adjusted life years Á Questionnaires Á Outcome assessment (health care) Abbreviations BEPTABetter ear pure tone average hearing loss CI Confidence Interval ENT Ear Nose and Throat EQ-5D UK tariff EuroQol 5d with British utility scoring function

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A causal model of patient satisfaction was tested, indicating that satisfaction was related to the patient's preoperative expectations and the quality of care given during the hospital stay and follow-up at the outpatient clinic. This emphasizes the relevance of patient education (to set realistic expectations) and counseling (need for care) by hospital staff in a cataract surgery setting.

The barriers identified have major implications for IMGs wishing to practise medicine in the Netherlands. Better support to overcome the difficulties inherent in migration and career change will result in better trained and acculturated doctors who will be more motivated to contribute to society.