Page 170 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 8
status may be more decisive in explaining differences, although a number of other reviews found few hospital differences in the US. The results suggest however that private hospitals may react more strongly to market incentives. This is especially relevant for the Netherlands, because it stipulates the importance of governing managed competition incentives appropriately.
This thesis contributed to the knowledge on the effectiveness of cost containment policies, with a focus on the Dutch healthcare system. Although different institutional settings and priorities might make the empirical results less relevant for other countries, general lessons hold international relevance: the challenges in effective cost containment shown in chapter 2 and 3, the estimation and application of marginal value of care in chapter 4, the limited power of purchasers to actively reallocate budgets and steer patients in chapters 5 and 6, and the effects of hospital ownership in chapter 7.
8.2 Strengths and weaknesses
This thesis takes a macro perspective, allowing identification of effects on a level relevant for policy makers. While a macro perspective is useful in identifying effects and trends relevant for policy makers, one limitation is that micro-level mechanisms may remain elusive. While chapter 2 provided an extensive mapping of cost containment policies that appeared in the literature, often the specific parameters are left open for interpretation. For example, literature may suggest coinsurance to be effective in containing costs, but it leaves open for example how to determine the optimal coinsurance rate, to set benefit inclusions and exemptions, or whether to introduce a stop-loss. Furthermore, factors such as public acceptance, political viability or effects on access and equity are also of importance. These choices require substantial policy scrutiny, for which research has yet provided few answers. More research is needed to provide guidance on how to design country-specific blueprints for a successful implementation.
Chapter 3 analysed effectiveness from a payer and societal perspective, excluding micro-level interventions to reduce costs. A payer and societal perspective is recommended to evaluate cost containment policies, as micro-level quality/efficiency improvements rarely result in cost savings at the macro level (Klink et al., 2017). For example, hospital cost savings due to a specific intervention may be compensated for by increases in other types of care. While exclusion of lower-level policies was necessary to inform policy makers on the effect of cost containment policies from the perspective of total costs, this strategy could risk missing effective policies. However, inclusion of lower level perspectives would require a thorough understanding of how cost savings on the micro level might translate to effects on the macro level. This is a promising area for future research.
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