Page 224 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

(QALY), with 95% confidence intervals ranging from €53,000 to €94,000 per QALY. The outcome may be used by the Dutch government to determine the optimal hospital expenditure cap, improve allocative efficiency and effectively make decisions which technologies should be reimbursed as part of the mandatory benefit package.
To improve efficiency of spending, managed competition was implemented in the hospital sector in 2006. Meanwhile, non-competitive purchaser systems were retained for long-term care, home care and personal budgets. The hypothesis was tested that insurers under managed competition purchase more actively than the non-competitive purchaser systems by reallocating more market shares between providers. The Market Volatility Index (MVI), expressing cumulative changes in market share between providers as percentage of the total market, was calculated for each market using annual statements from 2006 to 2014. Finding equally low volatility for hospital care and long term care of between 2% and 3% of the total budget, the main hypothesis was rejected. A substantially larger MVI, between 6% and 13%, was found for municipalities (single payers) and personal budget holders. Robustness checks, adjusting for the influence of market entry and exit, provider size, selective contracting and percentage of fixed costs, supported these findings. Although the Dutch reform aimed to stimulate active purchasing by multiple payers, we find little evidence that managed competition increased budget reallocations between providers by means of active purchasing.
In assisted reproduction in the Netherlands, success rate improvements lower costs per patient, as fewer secondary treatments are necessary. Providers may lose revenue, unless success rate improvements attract a sufficient number of new patients. Well functioning purchaser systems would steer patients towards high-quality providers, thereby containing costs while providing incentives for hospitals to improve quality. Using nationwide registry data from 1996 to 2016, very limited evidence was found that high- quality clinics attracted more new patients. The net effect of quality increases was shown to be a small decline in revenue. Therefore, we concluded that quality improvements are insufficiently stimulated by patient choice and active purchasing. Nevertheless, clinics have improved quality drastically over the last years, showing that despite limited patient and payer responsiveness, the healthcare system goals of increased efficiency and lower costs are attained in assisted reproduction.
Private provision of hospital care has been suggested as a means to improve access, quality and efficiency in healthcare. Chapter 7 reviewed evidence from Italy, Germany, UK, France, Greece, Austria, Spain and Portugal, suggesting that public hospitals are at least as efficient as or are more efficient than private hospitals. Access to private hospitals is higher for more affluent populations, especially in parallel private systems such as the United
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