Page 184 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 8
demonstrates that even in the absence of sufficient incentives, hospitals could still improve quality. Possibly, factors such as the intrinsic motivation of health professionals should be taken into account in purchasing.
What are the implications for countries contemplating installing or expanding principles of managed competition in their health systems? While qualitative evidence is mixed, empirical evidence of positive effects tends to be scarce in Dutch health care: only limited effects on inpatient costs and volume following the 2006 reform were found (Krabbe-Alkemade et al., 2017). Chapters 5 and 6 demonstrate that managed competition may not have had the intended effects in terms of active purchasing. Given the important role of purchasing in stimulating efficiency, each country needs a well-working purchasing system. However, the problems faced by active purchasing in the Netherlands are likely to be expected in other health systems as well. Theoretically, managed competition may be the best bet to improve purchasing, as supported by sparse empirical evidence demonstrating positive effects of competition in the US setting (Melnick and Zwanziger, 1988, 1995; Mobley, 1998b). Therefore, although the managed competition system in the Netherlands has its shortcomings, in potential the system could be a promising option to obtain efficient purchasing. This may be a time-consuming process, requiring continuous government intervention (Van Ginneken, 2015). Countries implementing managed competition should therefore not expect any immediate improvements, but in the long run, managed competition may be the best bet to improve active purchasing. Empirical evidence on the effects of active purchasing in other sectors is very much needed.
A number of policy recommendations and suggestions for future research that have been given throughout this thesis have been summarised in this section. Chapters 2 and 3 collected effective cost containment policies, finding few policy evaluations performed on a macro level. Most interventions were evaluated on either a provider level or a patient level. However, reductions in hospital costs or patient pathway costs do not automatically imply lower spending for payers or reductions in total healthcare spending. Therefore, cost containment policy evaluations should take a payer or societal perspective. Inclusion of non- peer-reviewed publications and literature in other languages may improve the overview of cost containment policy options, and add to evidence on effectiveness for more OECD countries. Effects of cost containment policies on other government aims, notably quality, efficiency, access and equity should also be collected to improve policy decision-making. These policy aims should be weighed in a transparent manner, for example by developing a tool to improve accountability for reasonableness. One promising research topic is to apply
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8.6 Policy recommendations and suggestions for future research