Page 187 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

assess active purchasing of insurers in the hospital sector, both on a macro level and through a case study in assisted reproduction. The results demonstrated that containing costs is challenging. Budgeting may be effective, but value may be lost when budgets are reduced. A multiple-equilibrium model provides guidance on how to improve effectiveness through combinations of policies. A number of policy options are available for the Dutch government to contain costs effectively. One promising set of cost containment policies would be to improve the preconditions for managed competition. Particular attention should be given to the healthcare purchasing market, as this market does not yet seem to function as envisioned. In addition, the government could further contain pharmaceutical costs by improving reference pricing systems and generic substitution. While privatisation of hospitals may be more in line with the principles of managed competition, it is unclear what is to be expected in terms of improvements in efficiency, quality and outcomes. The marginal value of hospital spending may guide policy makers in setting appropriate expenditure limits, assessing new technologies and improving allocative efficiency.
General Discussion
This thesis demonstrates that to target complex phenomena such as cost containment, a broad and multi-layered approach rather than a focus on a single aspect is required. Effective and efficient cost containment policy research requires incorporation of behavioural and countervailing effects, acknowledging the political and societal barriers and facilitators, linking the micro level to the macro level, combining quantitative and qualitative evidence and assessing both financial and non-financial incentives. Tackling the issue of sustainability of healthcare systems inevitably requires a multidisciplinary approach. This thesis provides a number of starting points, although much more progress can and should be made in this area of research.
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