Page 14 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Chapter 1
the growth of total hospital expenditures, starting with a 2.5% real growth cap in 2012, which was gradually reduced to 1% real growth (Rekenkamer, 2016). Under the expenditure cap, insurers were still supposed to selectively contract care, as long as total expenditures did not exceed the cap. Government efforts to contain costs therefore in practice mainly comprised safeguarding the managed competition system and enforcing expenditure caps. Other government tools to contain costs include increasing the mandatory deductible and restricting the mandatory benefit package (Rekenkamer, 2013).
Figure 1.2: The Dutch managed competition system (adopted from Van Ginneken et al., 2011)
  In the Dutch hospital setting, the government uses four main tools for cost containment: managed competition, cost sharing, benefit restrictions and budgeting (Rekenkamer, 2013). Government aims of cost containment and efficiency improvement are closely interlinked. Managed competition can be conceptualized as an alternative institutional setting to contain costs by improving efficiency. Cost sharing and benefit restrictions are additional tools to contain costs and improve efficiency. The introduction of a macro budget (expenditure cap) negotiated with the national associations of hospitals and insurers can be conceptualized as co-production. It expresses a sense of co-responsibility for cost containment. Co-production perfectly fits in the governance style of public policymaking in the Netherlands which is based less on hierarchical direction than on collaboration with main and state-recognized functional organisations representing the interests of their constituency (here hospitals, doctors, and insurers).
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1.3. Evidence on cost containment in the Netherlands





























































































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