Page 168 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 8
containing costs. In the peer-reviewed literature, the number of policies peaked in the early nineties and from 2009 onwards. Policy options in the literature more frequently related to market provision systems such as Germany and France than to public provision systems such as the UK. Market-oriented solutions were popular in the US literature, and increasingly so after 2009. In contrast, market-based controls were more popular in public provision systems, while market provision systems (other than the US) evoked relatively more suggestions for budgeting and price controls. This suggests convergence between market provision systems and public provision systems, while the US continues to focus on market-oriented policies.
In chapter 3 we performed a systematic review of the effectiveness of cost containment policies, building upon the literature collected in chapter 2. From the literature on OECD countries since 1970 we collected 43 empirical evaluations and 18 reviews. To accommodate highly variant methodologies we developed a tailor-made quality assessment. While 42 out of 61 studies demonstrated effectiveness, it also appeared that studies meeting high-standard methodological requirements were less likely to find a positive result for cost containment. High-quality studies showed that cost sharing and managed care competition were effective in containing costs, as well as generic substitution and reference pricing for pharmaceutical spending. We also found cost reductions for tort reform in the US. However, we did not find any evidence for over half of the policy groups identified in chapter 2.
Policy makers need information on the effects on health outcomes when deciding to reduce the budget or include a new technology into the benefit package. This is expressed in the marginal value of care: the effect on health, expressed in Quality Adjusted Life Years (QALYs), of a marginal reduction in the hospital budget. To guide Dutch policy makers in new technology assessment, we estimated the marginal value of hospital spending in chapter 4. A novel methodology was designed to incorporate the extensive data on spending and health outcomes available for the Netherlands. Using data from 2012-2014, we estimated the marginal value of spending at €74,000 per QALY with 95% confidence intervals between €53,000 and €94,000 per QALY. Compared to international estimates, value lost by a marginal reduction in hospital spending is low, suggesting that the expenditure caps between 2012 and 2014 of 2.5% real growth in hospital volumes may not have been too stringent. However, these estimates suggest that some technologies that recently entered the market, such as Orkambi® and Spinraza®, would have led to a net reduction in QALYs. Lastly, substantial differences in marginal values between disease categories may signal inefficiencies in the hospital sector, suggesting potential targets for active purchasing in the managed competition system.
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