Page 133 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Do quality improvements in assisted reproduction technology increase patient numbers in a managed competition setting?
conclusion, a positive effect of quality improvements on new patients may be present, but it is insufficiently large to provide financial incentives for clinics to improve quality.
4.1 Number of 4.2 Market share 4.3 interaction with region and treatments of new patients reform on quality in year t-1
2.161 Interaction with region and reform 13.159** Demographics .0071 .000019 9.97e-06 Time trend 34.275** .0395 .00628 Constant -68321.3** -74.94 -6.233 N (i,t) 243 (13,19) 243 (13,19) 243 (13,19)
Table 6.4: Lag structure regression results
-1830.356*** -9.849** -11.866*** Success rate in t-1 -481.751** 7.402** 1.650 Success rate in t-2 371.701 4.236 2.859 Interaction with region 11.290**
Success rate in t
Interaction with reform
2
R (within, between)
*p<.10, **p<.05, ***P<.01
(0.1635, (0.0845, 0.0319) (0.1275, 0.0052) 0.0449)
We demonstrate that quality improvements in ART have no significant effect on the number of treatments, despite what might be expected under the model of managed competition. Our results indicate that both patient choice and active purchasing fall short as means to stimulate efficiency. Patient choice may depend on non-success rate dimensions of quality, such as personal contact of physicians or of the actual travel time to the clinic. We do find evidence that the impact of patient choice increases when the distance to the nearest clinic is reduced. Possibly limited patient knowledge may explain low responsiveness (Vrangbæk et al., 2007). General physicians acting as gatekeeper, should inform patients or influence patient choice (Dixon et al., 2010). It is unknown whether GPs routinely use available quality information.
6.4 Discussion
Regarding active purchasing, results indicate that at the moment the system of regulated competition in the Netherlands does not stimulate active purchasing for assisted reproduction. As preconditions for active purchasing are better for ART than nearly any other treatment, it might be hypothesized that active purchasing by itself is falling short of policy expectations. This could be explained by low acceptance of insured patients to steering from third parties; patient choice is considered an important moral value. It could also reflect hospital market power, as resistance against selective contracting can be severe.
To improve the public’s acceptance of selective contracting insurers could increase transparency in terms of price and quality (Hibbard et al., 2003). However, selective contracting is only a viable option in competitive regions. This could result in a health gap between the urban and rural regions, if predominantly urban regions are motivated to
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