Page 225 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Kingdom and Greece. Evidence on quality of care is mixed. All in all, hospital ownership seems of relatively minor importance in determining hospital performance, although a number of factors, such as profit status and institutional setting, may confound this relationship.
This thesis set out to answer the question how governments, specifically the Dutch government, could contain costs effectively and efficiently. Literature reviews indicated that the Dutch government may contain costs effectively through (a combination of) budgeting and cost sharing, managed care and competition, as well as generic substitution and reference pricing. Budgeting may reduce health outcomes at the margin. The marginal value of hospital care, estimated at 73.600 per QALY, could guide policy makers in setting expenditure caps, assessing new technologies while monitoring and improving allocative efficiency. Managed care and competition may improve active purchasing through budget reallocations to high-quality providers. However, this may require active monitoring and intervention by the government, as currently managed competition in the Netherlands does not guarantee active reallocations. The results showed the complexity of containing costs effectively, supported by a multiple-equilibrium model presented in the discussion. Governments need to combine policies for multiple targets and monitor progress to attain the goals of efficiency improvements and cost containment.
Healthcare cost containment has been a major challenge, and will increasingly be so in the years to come. To target such a complex phenomenon, a broad and multi-layered approach is required. International research projects combining disciplines, approaches, study designs and levels of analysis are required to provide policy makers with some guidance to contain healthcare costs while retaining a high-quality, accessible healthcare system.
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