Page 19 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

General Introduction
These four themes aim to address knowledge gaps in the literature and to improve understanding of the macro-level mechanisms of cost containment and quality improvement. These themes also cover cost containment policy tools used in the Netherlands, relating to the performance of managed competition in efficiency improvements (theme 3), budgeting and new technology assessment (theme 2), while theme 1 and 4 examine additional policy options to contain costs. The use of mandatory deductibles as means of cost sharing is not explicitly covered in this thesis, although evidence on effectiveness in other countries is collected under theme 1.
Healthcare cost containment has been a constant policy issue: since conception of collectively financed healthcare, cost containment has been on the policy agenda. OECD countries have taken up different approaches to tackle this issue. Presently, a lot of evidence has been collected on how to contain costs (Tenbensel et al., 2012). However, as yet this information has not been collected systematically. No complete overview is available on which policy options the government can use to contain costs. Furthermore, a systematic overview of which policy options may be effective strategies is missing. This thesis aims to address this knowledge gap by collecting evidence on which options a government has to contain costs effectively. This aim is split into two research questions:
1.6.1. Effective cost containment policies
- What policy options do governments have to contain costs? (Chapter 2)
- Which policies have been effective in containing costs at the payer level? (Chapter
3)
Chapter 2 contributes to the literature by providing a comprehensive overview of the literature on policy options to contain costs. To this aim, a quantitative scoping review methodology was developed. This novel review methodology identifies articles mentioning one or more policies that may contain costs. These policies are registered and categorized, providing an exhaustive overview of which policies are mentioned in literature, and how often these are mentioned. This enables identification of trends in published literature on this topic.
Although a limited number of reviews collects evidence for effectiveness of cost containment policies, this has not been done systematically from a payer perspective. Chapter 2 is used as input for a systematic review on the effectiveness of cost containment policies. Due to the heterogeneity of the methodologies used, a new quality assessment tool was developed to assess diverse approaches to policy evaluations. Furthermore, the combination of both reviews provides a novel way to detect and quantify knowledge gaps. This could support researchers in their quest for strengthening the evidence base.
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