Page 37 - 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
Excluding the US, policy options in market based provision countries were covered three times as often in absolute terms compared to public provision countries. Interestingly, budgeting and pricing options are covered somewhat more for market provision systems in comparison with public types; while, in relative terms, market oriented policies and volume controls are covered more often for public provision systems. This might indicate that the literature holds a tendency to cover options that might fit better into alternative healthcare systems. The US tops all other countries with a very strong interest in the literature towards market oriented cost containment policies.
To check the robustness of the classification, two other classifications are used (Böhm et al., 2013; Docteur and Oxley, 2013). Docteur and Oxley differ from Joumard primarily in the classification of Australia, the UK and New Zealand. Appendix table 2.3 shows that countries such as Canada, Germany, the Netherlands, France, Japan and Australia have fewer market oriented policies (25-30% of total) compared to the UK, Sweden and New Zealand (39-50% of total). Thus, our results are somewhat sensitive to the grouping of the UK and New-Zealand with regard to market oriented policies. For most countries too few articles were found for each policy classification to be robust.
A full overview of cost containment policies holds the promise to form a powerful checklist, which helps policymakers to better structure their policies as well as discovering alternative options. This contributes to the art and craft of both policy learning and policy analysis. Since fiscal stress often induces reactive policymaking based on countries’ institutional legacies, a structural assessment of policy options might add to the policymakers’ toolkit.
2.5 Discussion
In this article, we set out to construct a conceptual cost containment framework. To this aim, we constructed a theoretical framework distinguishing four primary targets for controlling health costs: (1) price controls, (2) volume controls, (3) budgets, and (4) market oriented policies. By collecting 710 articles that describe a total of 2250 cost containment options, we were able to further specify our model into 41 separate categories of cost containment policies. Our review allows identification of trends in cost containment policy literature. In his 2002 paper, David Cutler discerns three universal waves of health reform in OECD-countries (Cutler, 2002). The first wave of reform provided equal access and universal coverage (about 1940-1970). This spurred large cost increases, leading to a wave of cost containment reforms (1970-2000). In order to increase efficiency, a third wave of market based reforms was initiated in the 2000’s. Therefore, we expected to find that literature about cost containment would increase up to 2000, after which attention would shift toward market oriented policies. Our data partly supports this theory. First of all, the
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