Page 186 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 8
could improve active purchasing. While this thesis demonstrates the limited activity in selectively reallocating budgets towards preferred providers, other aspects of active purchasing require further research. The question how insurers could best steer patients towards preferred providers requires more research, for example regarding the possibilities of prior authorisation, the role of the GP as (selective) gatekeeper and the role of patient information in choosing providers. Furthermore, insurers may develop activities to reduce unnecessary care and increase efficiency. How and to what extent this occurs in practice and what this will imply for cost containment is an area of future research. Future research on proprietary status should focus on the interaction between ownership, profit status and the institutional role of the private sector. Furthermore, the effect of differences in ownership in budget negotiations in the context of managed competition is a promising area for further research.
Currently, a trend is visible in the Netherlands towards healthcare networks, quality improvements and appropriateness of care (Kabinet Rutte III, 2017). While networks hold promise as a means to improve appropriateness of care, accountability and control are reduced, increasing the risk of cost shifting and supplier-induced demand. Proper management and monitoring of networks by purchasers is an area of future research. Several bottom-up initiatives are emerging in the Netherlands and other OECD countries, using quality improvement programmes to contain costs on a hospital level (Ekman et al., 2011; Hildebrandt et al., 2010; Kiers, 2017). In order to assess the potential of these initiatives as effective and efficient cost containment policies, evaluations on a payer level will be needed. Application of the multi-equilibrium model (appendix 7.1) would allow for an assessment of the effects of quality improvements on cost containment, while providing empirical verification of the most likely market responses. While these developments hold promise as a means to effectively and efficiently contain costs, more research demonstrating their effectiveness on a payer level will be necessary.
This thesis aims to contribute to the question how the (Dutch) government could contain costs effectively and efficiently. For this purpose a number of gaps in the literature were addressed. First, a comprehensive overview of cost containment policy options was distilled from the literature. Next, evidence on effectiveness was collected from a payer and societal perspective. A third review contributed to evidence on hospital characteristics associated with performance by reviewing differences between public and private hospitals in Europe. An encompassing empirical evaluation of hospital spending and outcomes rendered the marginal value of hospital care in the Netherlands. Last, empirical evidence was collected to
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8.7 Conclusions