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We avoided a spill over effect on the control group by means of the randomisation procedure, whereby people who formed the control group were not invited for the screening and not informed about an ongoing intervention.
Whilst expansionist medical tourism policies had been initiated in trade and tourism ministries of all three countries, there appears to be a spill over effect on ministries of health (MOH).
This enabled us to analyse data according to intention to treat, and the randomisation strategy ensured no spill over effect on the control group, as neither the control group nor their doctors knew that they formed a control group.
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In addition the study also examined the "spill over" effects of job insecurity on employees not directly affected by the mobility framework.
This design allowed detection of changes over time and any spill over effects of the intervention.
spill over effect vi.
Further major drawbacks were the possibility of spill over effects to the control group, 5 lack of intention to treat analyses due to loss of follow-up, and no information on non-fatal cases.
These considerations being the need for other approaches due to the limited availability of randomised controlled trials, measurement of a range of outcomes beyond Quality Adjusted Life Years (QALYs), consideration of inter-sectoral costs and consequences which may include wider benefits and spill over effects, and a focus on equity.
These programs could "tie-in" with successfully established self help group programs, helping to produce spill over effects.
Greece's financial problems have also provoked talk about a possible bailout by the European Union and fears of a spill-over effect on other weak, heavily indebted countries in the euro zone.
As for the scope of certification on a product level, the interview partners claim that the effect of a rising awareness concerning sustainable consumption and traceability of production that has been brought in by the sustainability discussion of biofuel production would also have a spill-over effect on other farming products, such as meat (LB, interview 4 May 2011).
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