Page 22 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 1
(Hollingsworth, 2003; Schlesinger and Gray, 2006; Sibbel and Nagarajah, 2012). Evidence suggests profit status may not be decisive in determining hospital performance. On the other hand, new public management predicts that privatization would improve quality and efficiency compared to public provision (Boyne, 2002; Walsh, 1995). Especially in European countries, controversy on privatisation of public hospitals demands for a review on performance differences between public and private hospitals (Jeurissen et al., 2016). To this aim, the following research question is formulated:
- Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care? (Chapter 7)
Chapter 7 uses a realist review methodology to collect evidence on empirical differences in hospital efficiency, quality and access from European countries since 2000. This could inform policy makers in the Netherlands and other European countries on whether private (non-profit) hospitals are indeed associated with improved outcomes in terms of quality, efficiency and equal access to care.
Cost containment in health care is a major policy issue. Healthcare is growing faster than the economy and ever more private and public resources are devoted to healthcare, threatening the fiscal sustainability of public budgets. Furthermore, not all spending is valuable; there is significant room for efficiency improvements. Part of resources currently spent on healthcare might be more productive elsewhere. Therefore, government intervention may be both necessary and beneficial. Over the years, Western countries have implemented many different policies to address the issue of rising costs, and many more policies have been suggested. Chapter 2 collects these policy options from the literature. However, in complex and adaptive systems such as healthcare, policies may not have their intended effect. Chapter 3 reviews effectiveness of cost containment policies. In order to make an informed decision regarding expenditure caps and new technology assessment, information is needed on the value that is lost when hospital spending is reduced. Chapter 4 estimates the marginal value for hospital care in the Netherlands. To contain costs and improve quality, the Netherlands has opted for a system of managed competition. In this system, insurers compete for patients by actively purchasing high quality care at low costs. Competitive markets are dynamic: stimulated by active purchasing, efficient providers gain market share, while inefficient providers lose market share. Chapter 5 measures these budget reallocations in Dutch healthcare markets. Steering patients to the most efficient providers could improve outcomes directly and indirectly: a larger part of the patient population is receiving high-quality care, while purchasing and competition on quality
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1.7. Conclusions