Page 28 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Chapter 2
that could lower spending without adversely affecting health outcomes are increasingly sought for. On the other hand, many cost containment strategies hold the risk to turn into policies of cost-shifting, sometimes with adverse health outcomes.
 Studies about cost containment policies are accumulating, providing opportunities to learn from other countries’ experiences (Cuckler et al., 2013; White, 1999). To categorize the existing knowledge a comprehensive cost containment model is required (Marmor et al., 2005). Some proposals for categorization were based on the distinction between supply and demand (Chernew et al., 2010; Murray and Frenk, 2010), sometimes added by additional layers that seek to catch the institutional dimension of healthcare, such as ‘public management, coordination and financing’ (Moreno-Serra, 2014). Jourmard et al. distinguish market based policies from command and control policies in an effort to assess health system efficiencies (Joumard et al., 2010). In an important article that evaluates the interplay between health systems characteristics and common cost containment policies, White introduced a distinction between ‘targets’ and ‘systems’ of cost control, whereby ‘targets’ mainly refer to policies affecting either prices or volumes; and ‘systems’ to the dimensions of the health system necessary for effective cost containment (White, 1999). However, such categorizations do not intend to be comprehensive, and moreover only evaluate a subset of cost containment policies.
The aim of this article is to construct a conceptual model to study cost containment policies and interventions, grounded in the relevant literature and including less common as well as more standard policies. We think that such a model can inform policymakers about possible cost containment directions. Moreover, it may serve to structure research on the effectiveness of specific groups of containment policies. We focus on the government goal of containment of the public part of health expenditure, implicitly aligning with most papers about cost containment. We use a broad scoping review and a perspective that aligns with the aim of containing costs on a system-wide level and include policies described for governments in all 34 OECD member states. Section 2 presents our conceptual framework. Section 3 describes our methodology to collect and categorize cost containment policies from the literature to complete our model. Section 4 describes our results. Section 5 concludes with a discussion of our results and policy implications.
We start by using the accounting identity expressing total costs as a combination of volumes and prices. Policies to contain total health care costs can directly target price or volume or alternatively, their interplay (Chandra et al., 2012). Next to direct price and volume controls we distinguish two types of policies that target both volumes and prices: budgets and
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2.2 The framework




























































































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