Page 47 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Effective healthcare cost-containment policies: a systematic review
Chapter 3
Effective healthcare cost-containment policies: a systematic review
The share of GDP spend on healthcare is increasing in all member countries of the Organisation for Economic Cooperation and Development (OECD), from 4.6% of GDP in 1970 to 9.0% of GDP in 2016 (Keehan et al., 2015). Despite a temporary slowdown in the growth of healthcare spending during the fiscal crisis, the pace of healthcare growth is again accelerating in many OECD countries (Keehan et al., 2015). Growth is driven by a combination of factors: ageing populations and work-force, technological advances, changing preferences due to higher incomes, higher wage growth due to lagging productivity growth, and increased coverage (Murthy and Okunade, 2016). Healthcare expenditure is financed primarily collectively (OECD, 2017a). The capacity to fund further health spending growth through increases in taxes and premiums seems limited (Trabandt and Uhlig, 2011). Hence, expanding healthcare budgets may increasingly pressure public spending in other areas, such as education or infrastructure (De La Maisonneuve and Martins, 2013). Furthermore, the healthcare sector is prone to inefficiencies such as unnecessary care, waste in healthcare, unwarranted clinical practice variation, administrative burdens, fraud and abuse (Berwick and Hackbarth, 2012). The combination of the limited capability of both the government and the economy to keep financing high healthcare growth, plus the awareness about the existing inefficiencies in healthcare, provides policymakers with a compelling argument to contain healthcare costs.
3.1 Introduction
Various countries have sought to address high healthcare cost growth through myriad policies (Chen et al., 2017; Craig and Howard, 2014; Gusmano and Allin, 2014). Many EU countries, for example, have been experimenting with strict cost containment policies during the fiscal crisis (Reeves et al., 2014). Salaries were reduced in France and Ireland (Mladovsky et al., 2012), and Greece likewise implemented policies to cut physician’s wages and fees by 25% (Karanikolos et al., 2013). Health budgets were reduced in Italy, Spain, Portugal and Ireland, amongst other countries (Mladovsky et al., 2012). Latvia and Bulgaria reduced the health budget by over 20% (Mladovsky et al., 2012). Although health systems differ, cost-containment policies have been remarkably similar across countries (Stadhouders et al., 2016). And while the effects may be context-dependent, still countries could learn from each other’s experiences, especially regarding effectiveness (Anderson et al., 2013; Stabile et al., 2013; Stanton and Rutherford, 2002).
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