Page 12 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 1
den Berg et al., 2011), waste or fraud (Couffinhal and Frankowski, 2017; Kelley, 2009; Morris, 2009) and differences in quality (Skinner and Staiger, 2015). Resolving these issues may reduce costs while increasing quality. Cost containment policies that do not specifically target these inefficiencies risk displacement of valuable care. When properly designed, healthcare cost containment may thus provide benefits for society, by reducing excess spending that adds little benefits, reducing crowding out of other valuable government expenditures, retaining solidarity principles in healthcare and increasing efficiency of spending. To achieve these goals, countries have implemented an array of cost containment policies over the years. Cost containment policies are estimated to explain between one third and two thirds of excess healthcare growth differences between countries (De la Maisonneuve et al., 2016). Well designed cost containment policies could thus substantially add to general welfare.
In this thesis, particular attention is given to cost containment policy in the Netherlands. In 2006, the Netherlands reformed the health sector by introducing managed competition to contain costs and improve efficiency (Enthoven and van de Ven, 2007). However, cost containment proved difficult throughout the first years after reform, placing the Netherlands amongst the highest-spending countries in Europe. Then, around 2013, healthcare growth stabilised. Did managed competition reform live up to its promise of cost containment and efficiency improvement? What lessons can countries draw that have implemented or contemplate health care reforms predicated upon the principles of managed competition? What additional cost containment policies may be effective? This is particularly relevant with respect to hospital cost containment, the biggest sector in healthcare (White, 1999). The aim of this thesis is to research how governments could contain hospital costs effectively and efficiently. For this purpose experiences with managed competition in the hospital sector in the Netherlands are researched in detail. This thesis contributes to our understanding of cost containment policy in the Netherlands, which hold lessons for other OECD countries. In the next section, the managed competition system in the Netherlands is introduced, after which the aims and outline of this thesis are presented in detail.
The Netherlands underwent major healthcare reform in 2006, when the new Health Insurance Act introduced principles of managed competition in large parts of the healthcare sector (hospital care, primary care, pharmaceuticals). The reform had no direct consequences for long-term care. Not earlier than in 2015 long-term care underwent a major reform; one of its most conspicuous elements was the large-scale decentralization of
4
1.2. Managed competition and cost containment in the Netherlands