Page 31 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Policy options to contain healthcare costs: a review and classification
targeted total costs (budgeting) or not. If the policy could not be considered a budget, we assessed whether a policy directly targets prices, by setting the reimbursement price or by targeting production costs. For example, introducing DRG’s (payment reform) does not set prices of DRG, but introduces a mechanism that could lead to more efficient provision. Therefore, it was categorized as a policy targeting efficiency improvements via market processes. However, a policy setting DRG prices was considered as rate-setting, and was categorized as a price targeting policy. Similarly, we assessed whether a policy directly targets volume, by reducing patient demand or by provider restrictions. For example, cost sharing targets patient overuse of care rather than a lower reimbursement price, and is therefore considered a policy primarily targeting lower volumes (Swartz, 2010). Policies stimulating moving from an inpatient setting to an outpatient setting do not mainly aim to restrict treatment volumes, but rather promote a more efficient setting for treatments, and were therefore categorized as a policy changing market structure to obtain cost containment. Finally, policies can promote a more efficient, lower cost outcome by influencing market processes. These include policies targeting market structure, like merger controls or changing types of third party payers, but also policies targeting to reduce inefficiencies in the overall performance of the health system, such as administrative excesses or tort reform.
Cost containment policies could be part of policy bundles, such as the Choosing Wisely campaign (Levinson et al., 2014). The cost containment aspects of these policy bundles were evaluated separately. For example, the notion of patient-centered care can include a number of policies which may lower costs, e.g. shared decision making, enhance patient choice in providers, increase possibilities to choose insurance and reduce practice variation to reduce overtreatment (Cassel and Guest, 2012). Separate policies within a bundle having different targets may be categorized at different places in our framework. Next, we created a third layer of categories to further specify our findings. This categorization was based on similarity between policies (inductive approach) (Elo and Kyngäs, 2008). Groups were given a term that covers the underlying policies. If any intervention did not fit into any existing group, a new group was created until all cost containment options were assigned to one single group. The second reviewer repeats this procedure to test the robustness of the categorization.
We validated the saturation of the model using two external sources. Berenson et al. present a complete overview of 36 cost containment policies that were implemented in US Medicare between 1970 and 2008 (Berenson et al., 2008). The Netherlands Bureau for Economic Policy Analysis (CPB) evaluates electoral plans of Dutch political parties on their budgetary effects. In 2015, CPB evaluated 104 policy propositions from ten different parties
23