Page 56 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
P. 56

Chapter 3
comparison with states that relied on non-competitive strategies (Melnick and Zwanziger, 1995). Cost containment retained over the long-term, even increasing bankruptcy risk for public hospitals (Mobley, 1998b). Contrary to the California experience, another study found that neither competition, nor regulation contained expenditures. Supply-side factors (e.g. per capita supply of hospital beds and prevalence of specialists) were found to be the main determinants of expenditure growth (Merrill and McLaughlin, 1986). One recent study on hospital competition in the UK found no effect on expenditures, although positive effects on quality of care were found (Gaynor et al., 2013).
 Payment reforms aim to align incentives of providers and payers. In Switzerland, expenditures of capitated networks were 6% lower than networks paid on a fee-for-service base (Reich et al., 2012a). For Medicaid, capitating GP payments reduced utilisation, but increased expenditures by $75 per patient due to the high payments necessary to include a sufficient number of physicians into the program (Gosden et al., 2000). Experiences from Medicaid mental health capitation in Colorado showed moderate cost reduction for the first two years, ranging from 0.5% for for-profit providers to 0.2% for non-profit providers; however, after two years the effects turned insignificant (Bloom et al., 2011). Interestingly, cost-containment effects were larger for for-profit providers, while for-profit status is associated with higher costs. This stipulates that for-profit providers may react more strongly to financial incentives. A literature review (9 studies) on the fiscal effects of P4P found mixed effects; the three most rigorous evaluations did not find any significant savings (Emmert et al., 2012). However, a more recent study on P4P for GPs found 1% lower expenditures as well as higher quality of care (Lemak et al., 2015). Another review found no cost evaluations of target payments for general physicians (Giuffrida et al., 1999).
Prospective payments and DRG payments fix per-patient prices irrespective of the number of activities per diagnosis. For a comprehensive overview of the implementation of DRGs in Europe, see (Busse et al., 2011). Following the implementation of Medicare PPS in 1984, significant reductions in hospital expenditure were found (Feder et al., 1987; Sloan et al., 1988). However, DRGs replacing per diem payment in New Jersey showed no significant cost reductions, as price reductions were offset by volume increases (Hsiao and Dunn, 1987). While DRGs may increase efficiency (Biørn et al., 2003), evidence on total spending is mixed. Implementation of a Medicare prospective payment system for home care in 2000 comprised a fixed per patient payment and a variable component, depending on treatment intensity. The fixed component was increased by the reform, while the variable component was reduced. In net, the reform slightly increased utilisation and expenditure, suggesting that incentives to increase the number of patients seem to have outweighed the incentives to contain per-patient costs (Huckfeldt et al., 2014).
48






























































































   54   55   56   57   58