Page 107 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Do managed competition and active purchasing go hand in hand?
selective because the budget they receive is less than in-kind LTC-tariffs. Therefore, we expect that the budget holder will engage in active purchasing (++).
Table 5.1: Overview of sectors in Dutch healthcare between 2007 and 2014
Purchaser system
Financing system
Freedom of provider choice for patients
Data on publicly financed budgets of Dutch health providers were extracted from annual financial reports from 2007 to 2014 from the online dataset DigiMV (CIBG, 2007-2014). Legislation mandates disclosure of annual statements by providers of hospital care and long-term care with more than one employee. Annual statements contain provider budgets, specified to payer system and type of care. As annual statements contain information on the current year as well as the previous year, data on 2006 was retrieved from the 2007 annual statements. Data were corrected for input errors and missing data by crosschecking with financial reports from the provider website. By internet searching providers with missing years in the dataset, mergers and takeovers were identified. Data from merged providers were aggregated retrospectively starting from 2006 to account for reallocation effects due to mergers.
Hospital care Long-term care Social services
Multiple payer system Single payer system Single payer system Multiple payer
(insurers) (regional care (municipalities) system (first- offices) party payer)
Exceptional Medical Health insurance Act Expenses Act
Social Care Act (Wet Exceptional
maatschappeljke ondersteuning,
Medical Expenses Act
ZVW) bijzondere WMO) (AWBZ)
Premiums (set by ziektekosten, AWBZ) Tariffs about insurer) and income- Payroll-related Tax funded grant to 70-80% of
related contributions contributions (set by municipalities (set tariffs of LTC (set by government) government) by government) in kind
Yes No No Yes
Freedom of payer choice for consumers
Yes Yes Yes Yes
Increased over time by Absent
reducing ex-post (overspending is High equalization forbidden)
High (no ex-post equalization)
Financial risk of payer
(Zorgverzekeringswet,
(Algemene wet
Law
Incentives for
active + - ++ ++ purchasing
5.3 Data and Methods
Personal budgets
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