Page 30 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 2
determined for a specific part of the healthcare system (sectoral budget) or a bundle of different sectors (macro budgets). We use the Structure-Conduct-Performance (SCP-) framework to categorize market oriented policies (Martin, 2010). Market structure influences the market conduct in terms of competition or collaboration, which then channels actual market performance. Policies can target each stage of the framework to obtain a lower-cost outcome.
Appendix figure 2.5 graphically summarizes our methodology and our research strategy. Since the aim is to provide a broad overview of the field of cost containment policies, we performed a scoping review (Arksey and O'Malley, 2005; Armstrong et al., 2011). We restricted our methodology to articles in the English language. Our review focused on policies enacted at the regional or country level (Liu, 2003; White, 1999). To retain a broad scope, a policy was included if the article states that it may contain costs. This may be sector costs, public costs or total health costs. Possibly our review includes policies which a paper claims to be able to contain costs, but which turn out to be ineffective. For example, policies may simply shift cost to patients without affecting the total cost level (Swartz, 2010). However, evaluating effectiveness of cost containment policies is beyond the scope of this paper. Policies may have other aims besides cost containment, such as increasing quality or equity. We include policies if the article states that the aim of a policy is, amongst other aims, cost containment.
2.3 Materials and methods
We identified the following keywords, in various combinations using Boolean operators and glossary terms when appropriate: Sector: healthcare, health care, long term care; action: lower, control, contain, decrease; object: expenditures, cost; Actor: government, policy. The following online literature databases were used: Pubmed, Embase, CINAHL, Econlit, Web of science, Business Source Complete, Sage Research Methods, IDEAS. Using these keywords, we found 8134 articles. We imported these articles in Endnote X7 and scanned each on title and abstract. Duplicates were removed using Endnote’s ‘Remove Duplicates’ function. If the possibility of inclusion could not be determined by title and abstract, the full text was examined. Finally, 710 articles met all of our inclusion criteria of which the following information was extracted: year of publication, authors, journal, title, the country or countries the article refers to, region, state or province the article refers to (if relevant), specific health sector, as well as all cost containment policies mentioned.
Two reviewers categorized the cost containment policies from the literature into one main category and one secondary category. For each policy, first we determined whether it
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