Page 69 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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                                                                                                                                                                                                                                    Table 3.4: Overview of study characteristics and quality assessment
Assessment* CvSbCb MR
Policy Macro budget
Paper Method Country Bazzoli et multivariate USA
al., 2005 regression
Effect Budgets
Significant reduction in CMS spending of 112 billion. Hospitals with high Medicare
b 331 22
Sector budget
Sturm et SR GER, GBR,
exposure experienced 9% lower growth in revenues than low exposure hospitals between 1996 and 1999. Volumes in high Medicare exposure nevertheless increased, while staffing rated declined, suggesting efficiency improvements.
Inconclusive evidence from Germany, a significant reduction in GP drug budget of 27% to 70% in the UK. An insignificant reduction in drug budget of 18% to 27% in Ireland.
10/12
Policy
Paper
Method
Country
Effect
Assessment*
Price limits
USA
Reference pricing
Lee et al. 2015
SR (16 studies)
CAN, ESP, POR, GER, SWE
DEN
Evidence from five countries points to cost saving effects of reference pricing on public costs. Effects on total costs are less due to increased cost sharing.
Generic substitution
Gothe et al., 2015
Joyce et al., 2002
SR (8 studies)
USA
Between 1997 and 1999, 2 tier plans with mandatory generic substitution reduced drug spending by 8% compared to 2-tier plans without generic substitution.
No evidence on the effects of profit controls in Ireland was found.
9/12
Cv Sb Cb Mb R
al. 2007 (2 studies) IER
USA
Price controls
CvSbCb Mb R 123 3 2 CvSbCb Mb R 111 1 1 9/12
Huckfeldt et al., 2014 Nguyen, 1996
2 stage probit simulated IV weighted OLS estimation
Price reductions of 21% in 1997 for home health agencies of the Home Health interim payment system resulted in 13% lower costs for home care.
For every 10% of reductions in fees due to the ’89 omnibus budget reconciliation act, health costs decreased by 6.3%.
Kaiser et al., 2014
2 stage logit IV estimation
Estimated reduction of over 10% after moving from external (based on international prices) to internal (based on cheapest alternative) reference pricing in 2005, corrected for changes in demand.
In 4 of 8 papers, generic substitution was associated with higher costs.
CvSbCb Mb R 222 3 3
Two-part logit/linear regression SR (1 study)
2333
2
Profit
controls
* For assessment scores, see appendix 3.1. Fractions indicate scores on the AMSTAR review scale (table 3.2). Cv: content validity, Sb: Selection bias; Cb: confounding bias; Mb: measurement bias; R: reliability. Legend: 3=high quality, 2=mediocre quality, 1=low quality. Note: SR: systematic review; IV: instrumental variable; OLS: ordinary least squares; CAN: Canada; GER: Germany; SWE: Sweden; DEN: Denmark; ESP: Spain; POR: Portugal; GBR: United Kingdom, IER: Ireland, USA: United States of America.
Lee et al., 2015
IER
9/12
                               








































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