Page 201 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

General Discussion
proposed extensions is given in table 8.3, allowing design of an agent-based model which can be calibrated to specific health systems. This would allow better quantitative assessment of the impact of cost containment policies.
Table 8.3: model extensions
Extension
Equilibrium
Description
distinguish between private and public spending
Introduce differences between payer bargaining
Explicate utility functions
Explicate treatment intensity
Model labour market
Explicate personnel composition
Cost sharing depends on reimbursement rate
Model income inequality
Eq 1
Eq 1
Allows sector budgeting
Distinguish between
sectors
Eq 2 Payers may have different motives (for-profit, non-profit, public) that influence their utility, and may influence responses to cost containment policy, for example in their response to reductions in demand.
Endogenize bargaining function
Eq 2 Payers may choose bargaining models based on preferences and implementation of cost containment policies.
Eq 2 Explication of utility functions allow a mathematical solution to the bargaining maximization problem (Halbersma et al., 2011).
Allow provider quality differences
Eq 2 Cost containment policies may be directed through budget negotiation towards low-quality providers
Model provider responses
Eq 3 Valuation of treatment intensity in terms of patient utility
Eq 3 Most likely response option depends on individual provider Eq 4 characteristics
Eq 4 Endogenize wage rate through labour market models
Eq 4 Capital costs may depend on provider characteristics
Allow risk premiums
Eq 4 Differences in personnel types, education and wage rates
Allow differences in productivity
Eq 2 Some providers may be more productive than others, which would Eq 4 influence bargaining positions
Eq5 If cost sharing is a function of the reimbursement rate, increases in
Model patient
the reimbursement rate reduce demand.
Eq 5 Patient utility may differ on culture and depend on local
circumstances. E.g. cost sharing acceptance or different demand in
sentiments
a crisis
Eq 5 Income inequality influences individual responsiveness to cost
Dynamic model
sharing
all Multi-year models allow to trace policies over time and allow
intertemporal effects (e.g. multi-year bargaining)
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