Page 16 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 1
Rekenkamer, 2013; van de Ven et al., 2009). The government sought to contain costs between 2006 and 2009 by transferring specific care (physical therapy, dental care) from the basic benefit package to supplementary insurance (Helderman and Jeurissen, 2010). However, measures to reduce the basic package have proven to be ineffective cost containment measures (Rekenkamer, 2016). To prevent cost-ineffective new technologies from entering the benefit package, the National Healthcare Institute advises the ministry based on criteria of necessity, effectiveness, cost-effectiveness and feasibility (Angelis et al., 2018). In order to prevent low-value for money technologies from replacing existing high- value care, cost effectiveness is one of the criteria used. However, the actual value loss when hospital spending is reduced remains unknown, and no formal threshold for cost- effectiveness has been implemented as yet (Angelis et al., 2018).
Cost containment is considered a government objective, strongly interlinked with efficiency improvement (Docteur and Oxley, 2013; Liu, 2003). Different interpretations of cost containment have been used; for example, “bending the cost curve”: lowering the growth of healthcare spending compared to historical growth rates (Cutler et al., 2009). Others interpret cost containment in the context of sustainability: equal or lower growth than the economy (Auerbach and Kellermann, 2011; Smith et al., 2009). Yet others equate cost containment to austerity measures: absolute reductions in spending, i.e. negative growth (Legido-Quigley et al., 2013; Reeves et al., 2015). More generally, cost containment is referred to a normative benchmark, being zero growth, the economy growth rate or historical growth rates. Measuring the effectiveness of cost containment requires a comparison between healthcare spending in a given country or region over a certain period of time with healthcare spending in another but comparable country or region (control group) over the same period of time. Another method is to compare health care spending of different but comparable payers (White, 1999).
1.4. Defining effective cost containment policies
Cost containment has been referred to in the setting of providers, e.g. within- hospital cost containment, or referring to patient journeys, where a certain new treatment may result in lower per-patient costs. For the government, two types of costs are of interest: total spending and public payer spending. The former encompasses all healthcare costs, the latter only the public part of total costs. Successful public cost containment may not necessarily reduce total spending, if public costs are shifted to private agents (White, 1999). Hospital cost savings may be of interest for the government in relation to efficiency and access, but not cost containment per se, as hospital cost savings may not translate to public or total cost containment. For example, patients may visit other hospitals or care settings in
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