Page 185 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Norman Daniels’ Benchmark of Fairness to cost containment policies (Daniels et al., 1996). This could provide a benchmark that compares advantages and disadvantages on a number of policy dimensions, which could in turn improve transparent policy making.
Mixed results were found for many cost containment policies, suggesting that no single policy is effective under all circumstances. To ensure effects, policies need to be monitored and fine-tuned after implementation. Anticipating behavioural responses may help in designing effective combinations of policies, including ‘soft’ policies to spur behavioural changes. Furthermore, some cost containment policies that were found to be effective, such as budgeting or cost sharing, may not increase efficiency. This also requires the need for a well-designed policy mix. A combination of policies may be more effective in preventing cost shifting and compensating effects, as predicted by the multi-equilibrium cost containment model. Further development of the multi-equilibrium cost containment model could support effective policy making. Lastly, more research is needed on differences in the design and implementation of specific cost containment policies as well as the interaction between different policies and institutional settings in relation to their effectiveness.
The opportunity costs of hospital care may be used as a threshold for assessing new technologies for adoption in the benefit package. However, given that supply-side thresholds based on the marginal value of care may be highly variable to changes in budgets and socioeconomic factors, demand-side thresholds may be more appropriate. More research will be necessary to answer the question how much society is willing to pay for new technologies. Nevertheless, marginal values provide important information on the stringency of the budget and the relative efficiency of health spending. In order to guide decision making on setting appropriate budgets and reallocating spending to improve efficiency, more robust estimates are required. Improvements in the current study in chapter 4 include adding more years, better quality information and better estimates of costs in the last year of life. Additional studies may be required, focusing on single disease categories, regional variation and health sectors other than the hospital sector.
Managed competition has the potential to greatly improve efficiency through active purchasing, yet so far little evidence has been found to support this claim for the Netherlands. Therefore, governments should aim to improve the bargaining position of insurers by means of active merger control (Schut and Varkevisser, 2017), improving public acceptance of selective contracting and improving credibility of selective contracting, e.g. by reducing mandatory reimbursements for non-contracted care (Van de Ven et al., 2013). Increasing quality transparency and production cost transparency is paramount to the success of selective contracting. Monitoring budget reallocations according to chapter 5
General Discussion
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