Page 38 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 2
number of cost containment articles shows two peaks. The first peak could reflect increased concerns about cost containment in the early and mid-1990s, consistent with the second wave of health reform, while the second peak might relate to the global recession of 2008 (Houÿez et al., 2014). However, given that over half of the articles consider the US, major political events such as the 1994 Health Care Act and the 2009 Affordable Care Act might also be reflected in the peaks in publications. Secondly, the literature shows a shift towards market oriented policies around 2008, consistent with the third wave of health reform. However, a different pattern emerges when the US is excluded from analysis: although market oriented policies slightly increased after 2000, volume controls remain predominant in literature. There, we do not find conclusive evidence that after 2000 the study of cost containment through market oriented policies increased in importance.
Our findings that some main targets are used more often than others might be explained by the fact that some policy effects are controversial, leading to more academic discussions. In contract, some policy directions might be already implemented and not under consideration for change. However, the relation between academic literature and policy-making is uncertain. Part of the literature included in our research describes policies already implemented, while other literature is suggesting policies for future policy-making. Also, academic literature might be lagging on policy making due to the time taken up by writing and publishing. For some OECD countries no articles were found. Adding gray and non-English literature possibly might align our analysis better to the interests of policy makers. English peer-reviewed literature might form an incomplete proxy of what policymakers and researchers actually consider to be possible options. Our validity controls show that although policies considered by policy-makers do not substantially differ from those found in the literature, some differences in relative use are visible. For example, the two external sources of policies showed relative high use of demand policies, like cost sharing and benefit package reductions.
The relative attention on cost containment policies seems to differ between types of health system. Higher numbers of cost containment policies in market provision systems like Canada and Germany might reflect that these have more difficulties in containing costs (Or et al., 2010), although a publication bias towards market based provision systems could also be present. Furthermore, we expected that market based provision systems would attract relatively more attention on market oriented cost containment policies (Lameire et al., 1999; Saltman et al., 2004). Similarly, public provision systems might be expected to attract more attention for budgeting and price and volume controls. However, market oriented policies are comparatively more often suggested for public provision systems like the United Kingdom and Sweden, while budgeting and pricing strategies are more often
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