Page 181 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

pressures amongst health professionals. In turn, health professionals confronted with budget pressures may revert to rationing of care to patients. As a result, the effects of new technologies will spread throughout the health
General Discussion
system.So far, little is known on how these
decisions are taken in practice on the level of
providers and health professionals. In practice,
explicit prioritisation seems to be sparsely
used. Since 2015, 14 cases have been identified
for Australia, Canada, the UK, New Zealand and
Sweden (Polisena et al., 2013; Rooshenas et al.,
2015). A potential barrier is that even low-
value care may provide value for a subset of
patients (Garner and Littlejohns, 2011). No
relation was found between a new technology
uptake and prioritisation or rationing in either
the UK or the Netherlands (Adang et al., 2018;
Appleby et al., 2009; Schaffer et al., 2015;
Schaffer et al., 2016). Absence of sufficient information was mentioned as a limiting factor in taking prioritisation and rationing decisions (Marks et al., 2013). In order to reduce value lost due to budget restrictions and uptake of new treatments, more research will be necessary on how to improve decision making on the micro level. Measuring cost effectiveness of existing treatments and empowering providers to prioritise based on cost effectiveness may improve the efficiency of prioritisation and rationing mechanisms. When faced with budget restrictions and new technologies, efficient rationing and prioritisation may allow providers and health professionals to reduce negative effects on health. Recently, initiatives have been aiming to identify low-value care (Wammes et al., 2016). Chapter 4 provides additional guidance through calculation of disease-specific and age-specific thresholds, showing substantial divergence. Disease categories with relatively low marginal values, such as diseases of the blood, pregnancy and neonatal care may require further studying to identify cost-ineffective treatments.
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