Page 55 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Effective healthcare cost-containment policies: a systematic review
 found short-term cost increases of 9%-16%, but thereafter a diminished cost growth of 0.5%-1% on an annual basis (Costa-Font and Moscone, 2008).
Registered nurses, nursing assistants, pharmacists or primary care physicians may perform some tasks and procedures traditionally performed by medical specialists more cheaply. One review (11 studies) found that substitution of tasks towards nursing assistants and pharmacists may lower expenditure, although the quality of the evidence is deemed too low to draw general conclusions (Laurant et al., 2009). A second review (3 studies) report marginally lower costs of delegating tasks to primary care physicians on emergency care departments (Khangura et al., 2012).
Non-profit and public providers seem to operate with lower expenses. One review (8 studies) found that for-profit providers on average charge 19% higher prices than non- profit providers (Devereaux et al., 2004). A second review (37 studies) found 23 economic comparisons that favoured non-profit ownership, 5 that favoured for-profit ownership and 9 that were inconclusive (Rosenau, 2003). A final study found for-profit MCOs to be more costly per member, although their results were not consistent (Schlesinger et al., 1986).
Evaluations of policies aiming to reduce cost by influencing market conduct primarily focused on the effects of competition, payment reform and care coordination. In the latter category, a number of case management programs have been evaluated. The Illinois Health Connect and Your Healthcare Plus intervention produced savings of 7% and 9%, respectively (Phillips et al., 2014). A Medicaid primary care case management program showed maximal program savings of 7% in Medicaid expenditure (Muller and Baker, 1996). An evaluation of Medicare case management for high-risk patients found cost savings of $7.7 million over three years, rendering a Return on Investment ratio (ROI) of 1.40. Reductions in readmissions and increases in appropriate medication were found (Hawkins et al., 2015). A health management program of a large California employer saved between $8.4 million and $8.8 million, rendering a ROI ratio of between 4.56 and 4.73 (Ozminkowski et al., 1999). Although one study showed per patient cost decreases of $89 for high risk patients due to case management, these savings were insufficient to cover the total costs of the program (Kranker, 2016). For other forms of care coordination, less evidence was available. One study demonstrated that GP continuity in Belgium lowered expenditure by 11% (De Maeseneer et al., 2003).
Market conduct policies
Competition has proven to contain costs in California during the 1980s and 1990s. A study on pro-competitive reforms found cost decreases of 12% in high competition regions (Melnick and Zwanziger, 1988). Lower growth of expenses could also be noted in
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