Page 135 - 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? Data used for this research is available upon request or can be accessed through the
Appendix to Chapter 6 Supplementary material
following link: https://www.degynaecoloog.nl/nuttige-informatie/ivf-resultaten/
Table 6.5 shows the result of alternative definitions of the reform year. It could be that the reform was anticipated, suggesting a stronger effect when 2006 is taken as a reform year. Also, it could be that the reform took time to implement, suggesting a stronger effect when 2008 is taken as a reform year. In 2012, ex-ante compensation was reduced to improve active purchasing. We research in regression 3 whether the effect was stronger after 2012. We find that the choice of reform year does not influence the results. No significant differences between the alternative specifications were found. We can conclude that the reform did not have a significant influence on the relationship between quality
Reform years
improvements and new patients. 1 Reform after 2006 2 Reform after 2008 3 Reform after 2012 Success rate in t -11.591*** -12.595*** -12.415*** Success rate in t-1 1.233 2.418 1.124 Success rate in t-2 2.978 3.426 2.995 Interaction with region 11.869** 10.180** 11.309** Interaction with reform 1.049 3.455 1.957 Interaction with region and reform 12.583** 13.245** 13.102** Demographics 8.32e-06 .000014 .00001 Time trend .0168 -.00328 .0114 Constant -26.770 12.573 -16.170 N (i,t) 243 (13,19) 243 (13,19) 243 (13,19) R2 (within, between) (0.1217, 0.0130) (0.1393, 0.0004) (0.1285, 0.0062) *p<.10, **p<.05, ***P<.01
Table 6.5: Reform years regression results
Our model assumes a 50% dropout rate. However, in literature this figure is surrounded with a high degree of uncertainty. Therefore, we test alternative assumptions regarding the dropout rate in table 6.6. We find similar results for all dropout rates, although the size of the effect declines for higher dropout rates. Therefore, we conclude that the dropout rate used in this study does not alter our conclusions. However, we do assume that the dropout rate is the same for all clinics. Clinics differing in their dropout rate could significantly influence the results. Specifically, if high quality is combined with a high dropout rate, the effect of quality improvements on new treatments is larger, while if high quality is combined
Dropout rates
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