Page 189 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Third party payer structure
General Discussion
New technologies and pharmaceuticals generally are automatically included in the benefit package. In case of doubt on effectiveness, temporary exclusion may be given (called
New technology control
“sluis”). In that case, new technologies are assessed by the National Health Care Institute (Zorginstituut Nederland (ZIN)) and a recommendation is given to the Minister of Health
Patient empowerment
Provider structure
Responsibility redefinition
Antitrust policy
Payment reform
Prospective payments
on whether to include the new technology into the benefit package, giving the Minister possibilities to negotiate on prices.
In 2012 a choosing wisely campaign was launched (called Verstandig Kiezen) to empower patients and professionals to improve shared-decision making in healthcare.
The competing insurer structure is core to the 2006 reform. However, managed care plans, restricted choice plans etc. Have been marginally developed
The 2006 reform spurred innovative provision models, specifically a sharp increase in independent treatment centres. International developments, such as the patient centred medical home, telemedicine, etc., have been slowly spreading to the Netherlands.
Government level
In 2015, part of LTC (home ancillary care) was decentralised to municipalities and part (home nursing care) was centralised to nationally operating health insurers.
The government actively stimulates task redistribution from medical specialists to nursing staff.
Ownership
Private non-profit provision by foundations is the norm, although private for-profit and non-profit provision by companies has become more predominant.
A formal body has been responsible for merger control and antitrust policy, although performance on both objectives has been heavily criticized.
Risk redistribution
In 2012, ex-post risk equalization for hospitals was gradually removed. The ex-ante risk equalisation system is well-developed, although additional improvements may be possible.
In 2012, a minor reform of the DBC system took place (DBC-DOT). Some experiments with shared savings (Hayen et al., 2015), bundled payments and pay for performance have been performed, but so far this has been a marginal phenomenon
Competition
Payer and provider competition has been a cornerstone of the 2006 reform. In long-term care, competition is scarcely used.
Prospective payments have been introduced in most or all healthcare sectors. Some retrospective elements may be present in LTC.
Care coordination could be improved; insurers are little active in care coordination, and provider coordinative efforts have been complicated by different financial budgets (called schotten). Coordination programs for specific diseases, e.g. Parkinson’s disease, COPD and heart failure have been launched.
Coordination
Consumer choice has been improved by the 2006 reform through standardisation of
benefits and choice supports. Still additional efforts could be made.
Contracting Legislature to improve selective contracting failed in congress in 2012.
Patient choice Patient choice is considered an important moral value in the Netherlands and is
Consumer choice
Health IT
Tort reform
Transparency
Reduce waste
Innovation
permitted in all health sectors. However, information to support patient choice is mostly lacking.
Legislation to implement a national electronic patient record system failed in congress in 2012. As a result, health IT systems rarely allow data exchange between providers. Provider liability is not considered an issue for cost containment in the Netherlands, and tort reform is unlikely to save any costs
Administration
Administrative expenses in the Netherlands are considered high, and much of a societal issue. Administrative simplification is high on the policy agenda
Despite 2015 being the year of transparency in healthcare, little has been achieved in increasing transparency on any level. Prices and quality remain obscure.
Management
The role of management has received some attention in LTC when improvement programs were started in 2015 (called In voor zorg!)
Waste reduction has been an important topic for the government, for example in 2013 a website was created where waste could be reported
Reduce fraud
Fraud reduction has received particular attention in personal budgets. In 2013, a taskforce on fraud reduction was started to improve fraud detection of personal budgets. In 2016 a platform was created to support cost-saving innovations in healthcare.
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