Page 156 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 7
the incentives built into the health care systems, because they seem to be an important driver for either the divergence or convergence of the private and public sector. FP providers seem to respond more intensely to incentives, which may produce undesirable policy effects if the incentive structure is not well designed. Fine-tuning such structure, e.g. hospital payment systems, becomes even more important if the role of the private sector increases. It is not clear if all countries hold the steering powers to fulfil for such preconditions. Thirdly, despite popular opinion that enhancing the role of the private sector increases efficiency, we find little evidence to support this claim. Most evidence shows that public hospitals are as efficient as or more efficient than private counterparts. For Beveridge countries, we found that access to private hospitals is substantially worse for patients with either low incomes or a more complex case-mix. Finally, this review highlights that policy ‘shopping’ among research results, although possible for this subject, is dangerous. The evidence on private sector performance should be critically assessed; research designs (i.e. indicator specification, methodology and sample selection) do cause divergent results between studies. Our assessment is that, the supposed superior performance of the private sector – and especially the private non-profit hospital sector – for Beveridge countries depends on full inclusion in the health system to guarantee broader access to the private sector; for all countries it then is important to design incentive structures that minimize the opportunities for opportunistic behaviour and for quality of care includes transparency. Overall, this review could contribute to the discussion on the role of the private sector in providing hospital services in the European Union and how different systems, institutions, and incentive structures might affect the public and private hospital sector.
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