Page 21 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Despite its importance, most evaluations are mostly qualitative in nature (Klasa et al., 2018; Reinhard Busse and Elke, 2007). Up to date little empirical research has been done on purchaser performance. Theme 3 contributes to the literature by providing quantitative evidence on one aspect of strategic purchasing: the reallocation of budgets over providers. Ideally, purchasers steer patients to hospitals that provide high-quality care at acceptable costs, and away from expensive and low-quality providers. This would imply that in a well- functioning system, budgets of high-performing providers grow at the cost of low- performing providers. To research whether this is promoted by the managed competition system in the Netherlands, the following research questions were formulated:
- Do quality improvements of providers lead to increased shares of new patients in a managed competition setting? (Chapter 6)
Chapter 5 assesses to what extent budget reallocations take place in a managed competition system. To this aim, a new, broadly applicable indicator for budget reallocations was developed and applied to four different health systems within the Netherlands. Policy- makers could use this indicator to compare and adjust payer systems. Furthermore, the results provide empirical insights in the effects of managed competition in the Netherlands with respect to active purchasing. Chapter 6 employs a case study on purchasing to stimulate quality improvements. Conditions for selective purchasing could be considered relatively optimal for assisted reproduction (van der Geest and Varkevisser, 2008). In assisted reproduction, higher pregnancy rates result in lower costs per patient due to fewer attempts necessary. Purchasers therefore should be stimulated to purchase selectively, as this will both increase quality and reduce costs. Chapter 6 investigates to what extent quality improvements are rewarded by an increase in the number of new patients. This could inform scholars and policy makers on the combined effects of patient choice and active purchasing under managed competition.
Structural hospital characteristics may influence hospital performance and, consequently, costs and efficiency. Two factors often associated with performance are profit status and ownership, distinguishing between non-profit public hospitals, non-profit private hospitals and for-profit private hospitals (Pita Barros and Siciliani, 2011). Hospitals in the Netherlands are structured as non-profit private hospitals (Jeurissen, 2010). Profit status of Dutch hospitals has been much debated (Jeurissen, 2010; Plomp, 2009). A body of research has been performed on profit status, predominantly in the US, finding mixed evidence
1.6.4. Structural hospital characteristics associated with performance
General Introduction
- To what extent does managed competition in the hospital sector lead to reallocations of provider market share? (Chapter 5)
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