Page 196 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 8
propose a matrix of health status and the desire to seek care (figure 1). Desire to seek care ( ) depends on the expected utility of seeking care given the need ( ) and the disutility
of paying for care (cost sharing):
Cost sharing in turn may be a function of the reimbursement rate, which is for sake of clarity not taken into account. Most people have a high desire to seek care when the health status deteriorates (upper right quadrant), or do not seek care in case of minor illness (lower left quadrant). However, a fraction of the population seeks care without medical necessity (upper left quadrant) or shies away from seeking medically necessary care (lower right quadrant).
By individually modelling each individual’s ability to assess his health status, one would end up in the familiar case where reductions in demand both reduce overtreatment and increase undertreatment at the same time. Furthermore, some policies, notably health education, can improve the ability of individuals to assess their health status, and thereby reduce over- and undertreatment at the same time. Lastly, some policies restrict access to care for certain patient groups, such as selective contracting, prior authorization and utilization review. If these are targeted towards objective health status, one would come to the familiar finding that selectively reducing access may be unpopular to patients, as perceived needs may differ from health status. Through political processes and patient association lobbying, budgets may be increased to accommodate access based on perceived needs rather than health status, potentially increasing ‘unnecessary care’ from a medical perspective.
The model provides us with possible responses to cost containment policies. However, this does not tell us which response is most likely. Based on theory and empirics, some predictions can be made. To illustrate the model, I will describe the effects of four of the
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Applying the model