Page 33 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Policy options to contain healthcare costs: a review and classification
Confrontation of our model with real world cost containment policies did not result in alteration of the model. Of the 36 implemented policies in Medicare, 32 were literally present in our database, and for 4 policies similar terms were found. Of 104 real life propositions made by Dutch political parties, 37 were featured literally in the review database; while similar terms could be found for another 52 policies. Sixteen policies did not have a counterpart in the literature, but could be categorized using the existing categories from the framework. The validation did not lead to revision of the framework.
Figure 2.2 suggests that the toolkit of policymakers to limit spending growth healthcare contains up to forty-one explicit strategies. This figure also illustrates that some of the primary strategies that are considered comparatively more effective, such as budgeting and price controls (Stabile et al., 2013), are covered less intensively in the literature. The structure of the third party payer market has been proposed and studied the most among our database (185), followed by payment reforms (174) altering the method of reimbursement (e.g. DRG’s, capitation, pay-for-performance), cost sharing mechanisms (160), and policies aiming to increase appropriateness through utilization review, guidelines and reduction of regional variation (148).
Some categories such as patient choice of providers (3), cost reducing innovations (6), and the reduction of fraud (8) and waste (9) have been hardly mentioned or studied. We conclude the same for important underlying cost drivers such as wages (21) and capital (11). Demand policies make up 17% of all cost containment policy proposals (387 of 2250). Demand policies initially comprised 10% of all policies during the 1980’s, increased to 20% in the early nineties and stabilized afterwards (data not shown). Strategies with more inconclusive outcomes on cost containment seem to have been covered the most, perhaps suggesting that searching for efficiency dominates pure cost control.
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