Page 110 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Chapter 5
(Appendix figure 5.3). In the hospital sector, 42% of providers are ITCs, while for elderly care and disability care providers, 57%, respectively 59% of patients are receiving home care (out-patient setting). The average provider receives almost €3 million from municipalities for social care, while personal budget care is significantly smaller, averaging €0.5 million. Capital expenditures are on average 10% of total expenditures.
Table 5.3: Descriptive pooled statistics, 2007-2014
Hospital budget Elderly care budget Disability care budget Social care budget
Total provider budget
  € 67,000,000 € 114,000,000 € 774,000,000                 2125 0.42 0.49 1 1815 € 26,500,000 € 44,200,000 € 508,000,000                 4274 0.57 0.33 1 4213 € 38,100,000                 € 64,200,000           € 623,000,000           1525 0.59 0.30 1 1468 € 2,988,893                 € 6,483,502           € 98,200,000           3241
          Variable
Mean
Max
N
                  % ITC
                    % elderly home care
          % Disability home care
         € 516,271     € 1,029,801   € 15,900,000     4125
  Personal budgets spent at in-kind LTC
 providers
       € 35,300,000                             € 75,600,000             € 902,000,000       10387
0.10 0.09 0.36*                 9879
Source: Annual reports database (DigiMV 2007-2015). Note: all minimum values are zero. *99% of the distribution
  Capital expenditures ratio
         Figure 5.1 shows mean volatility in hospital care and long-term care is around 2-2.5%, while volatility in social care and personal budget care is between 8-10%. The results for elderly care, disability care, social care and personal budget care confirm our hypotheses. Based on differences in the institutional setting, we expected volatility to be higher in hospital care than in elderly care and disability care. We find no confirmation for this hypothesis, volatility in hospital care being equal to LTC care. In both sectors, volatility is lower than changes in the macro budget (up to 10-12%, see table 5.3), suggesting that these fluctuations in the macro budget are passed on to providers with little concern for reallocations. About half of the volatility is structural, i.e. either a multi-year trend in increases or declines in market share, suggesting year-to-year fluctuations may explain part of the budget reallocations. However, structural reallocations are comparatively low in the hospital sector, suggesting structural active purchasing to be relatively low for hospital care. Based on a number of policies taken to improve the purchasing function in hospital care, specifically reductions in ex-post compensations, we expected market reallocations in the hospital sector to increase over time. However, figure 5.2 shows a downward trend in volatility in all sectors. Again, this confirms our finding that active purchasing in hospital
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5.4.1 Main results: market volatility per sector
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