Page 129 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Do quality improvements in assisted reproduction technology increase patient numbers in a
quality indicators for angioplasty and hip replacement (Beukers et al., 2014; Varkevisser et al., 2012).
1. Changes in success rate are positively related to changes in the number of treatments
2. This relation is stronger after the reform in 2006
3. This relation is stronger in more competitive regions
The paper is structured as follows: The next section presents the research method, after which our results are presented. We end with a discussion and policy recommendations.
To analyze the relation between success rate improvements and growth in the number of treatments, we use a panel database from 1996-2016, routinely collected by the Dutch Institute for Obstetrics and Geriatrics (NVOG). This institute annually sends questionnaires to the heads of department of all clinics to collect data on the number of started treatments, the number of placed embryos, the number of 10 week pregnancies and the number of twins/triplets. Data on demographics were derived from the Dutch Statistical Bureau (CBS, 2016). We define a variable (R), which is 1 when the clinic is in a competitive region and 0 if
6.2 Data and methods
managed competition setting?
 In addition, conditions for selective contracting are compelling. In 2006, Dutch healthcare reform introduced managed competition: insurers compete for patients under a mandatory coverage, where risk equalization prevents cherry picking. Competition on premiums incentivizes insurers to purchase actively to improve provider quality and reduce the cost of care. ART is a field in which insurers can clearly attain both of these goals: steering patients to high quality providers can increase quality and reduce costs. Therefore, we expect that insurers seek to steer patients through selective contracting and active purchasing strategies, especially after the 2006 reform (Cooper et al., 2011; Howard, 2006).
For clinics, we therefore expect quality improvements to pay off in terms of revenue due to additional patient streams (Howard, 2006; van der Geest and Varkevisser, 2008). Furthermore, we expect that this effect increased after the 2006 reform. The relation may be influenced by demographics, as regional changes in the number of eligible patients (women aged 30 to 40) can influence clinic patient numbers. Also, travel time may be of influence (Exworthy and Peckham, 2006). Patients have to visit the clinic a number of times in a short time span, which could reduce willingness to travel long distances (Wu et al., 2013). Therefore, we expect the relation between success rate and market share of the clinic to be stronger in regions where multiple clinics are within traveling distance (Cooper et al., 2011). From these premises, we can formulate the following hypotheses:
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