Page 173 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

preferred providers is an important topic for future research requiring combined efforts of social, political and economic disciplines.
This thesis aimed to analyse how governments can effectively contain costs. Besides effectiveness, policy makers should also consider other policy aims when choosing optimal cost containment policies (Daniels et al., 2009). Examples are effects on quality, equity, access, solidarity and accountability. Transparent and just policymaking requires scoring cost containment policies on multiple dimensions. Accountability for reasonableness, for example using a Benchmark of Fairness developed by Norman Daniels (Daniels et al., 2000; Daniels et al., 1996; Daniels et al., 2009), could be applied to cost containment policy decision making. Additional research could demonstrate the usefulness of multi- dimensional decision-making tools in transparent policymaking.
Politicians and policymakers often routinely favour an increase in efficiency to improve the fiscal sustainability of health care over more ‘hard’ choices such as reducing benefits or increasing out-of-pocket payments. Many studies seem to support such claims, pointing towards the existence of substantial ‘waste’ within the healthcare sector (OECD, 2017b). Considering such political support and empirical estimates of the level of waste, the difficulties of real life implementation of such policies is remarkable. Reducing wasteful spending may receive more support in the field, up to the realization that this may imply reductions in incomes for health professionals or access for patients (Evans et al., 1989; Lomas et al., 1989). In a complex, adaptive system, policies to improve efficiency and reduce costs may be circumvented more easily than command-and-control policies. Credible policymaking needs to take into account interests of different stakeholders, which may not be aligned with aims of cost containment.
8.3 Effective cost containment policies
8.3.1 Lessons for the Netherlands
We can learn a lot from experiences of cost containment in other countries. Chapter 2 found that most cost containment strategies could be implemented in any country. To illustrate, table 44 in appendix 7 provides an overview of 41 cost containment policies and their potential application in the Netherlands. In nearly all categories policies have been enacted or formulated to a certain extent, with most policy options remaining relevant. Two exceptions are prospective payments, which more or less have been implemented, and tort reform, which is not a source of concern in the Netherlands. We will now highlight the possible application to the Netherlands of the policies that have proven to be most likely to be effective according to the conclusions drawn in chapter 3.
General Discussion
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