Page 167 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

General Discussion
This chapter starts with a summary of the main findings of this dissertation (8.1) and a discussion of its strengths and weaknesses (8.2). Next follows an in-depth discussion on three main topics. The international findings on effective cost containment policies are discussed for the Netherlands, including a few suggestions to improve its effectiveness (8.3), followed by a discussion on the implications of the marginal value of hospital care (8.4) and the performance of managed competition in the Netherlands (8.5). Policy recommendations and suggestions for future research are presented in section 8.6. The chapter ends with some concluding remarks (8.7).
Chapter 8 General discussion
This thesis focuses on effective and efficient cost containment policies from the perspective of the Netherlands. Chapter 1 discussed the necessity of an effective cost containment policy to reduce the burden on public finance and improve efficiency in the health sector. In 2006, the Netherlands implemented a particular approach for cost containment in the hospital sector, based on the principles of managed competition. In this system, competing insurers bear responsibility for both quality improvement and cost containment. The Dutch government generally underwrites the functioning of the managed competition system while keeping direct intervention to a minimum. Additional cost containment policy instruments include expenditure caps, statutory benefit package restrictions and an increase of the level of deductibles. Evidence on the functioning of the managed competition system, mostly qualitative, is mixed. Evaluations suggest that the expenditure cap did not improve efficiency, benefit package restrictions have been ineffective in cost containment, and cost sharing has had little effect on total costs (Plexus, 2014; Rekenkamer, 2013; van de Ven et al., 2009). This thesis addresses these issues by providing an overview of cost containment options, quantitatively assessing aspects of managed competition and providing a threshold for setting the expenditure cap and restricting the benefit package.
8.1 Overview of the main findings
To obtain an overview of cost containment policy options, chapter 2 collected the peer-reviewed articles on cost containment policies in OECD countries (including the Netherlands) that have been published since 1970. From 710 articles, 2,250 policies to reduce costs were extracted. Based on similarity, these policies were categorised in four main categories: budgeting, price controls, volume controls and market-oriented policies. This overview only included policy options, not whether these were actually effective in
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