Page 49 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders
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Effective healthcare cost-containment policies: a systematic review
We performed a systematic review to identify evidence on the effectiveness of known policy options to control payer expenditure. Our approach follows the Centre for Reviews and Dissemination guidance protocol for undertaking reviews in healthcare (Khan et al., 2001). Standard rapid review procedures were followed with respect to handsearching journals, expert consultations and article translations (Tricco et al., 2016). Inclusion criteria are defined according to the Patient, Intervention, Comparator, Outcome, Study design (PICOS) framework (Table 3.1) (Liberati et al., 2009). Effective cost containment is defined as lower total expenditure or payer expenditure compared to a control group, including before-after comparisons within the same population and comparison to a similar population (e.g. insured population of insurers, regions or countries) (OECD/WHO/Eurostat, 2011). Our study population is defined as the insured population (enrolees) of one or more payers, either private or public. This excludes studies using per patient expenditure, per provider expenditure, volumes or prices as sole outcome measure. Containing the cost per unit of service, i.e. increasing efficiency, is excluded, except when this is shown to lead to reductions in total expenditures. Other outcomes – in particular quality, equity and efficiency – are policy relevant as well, but beyond the scope of this review. This review only includes OECD countries.
Population Health sectors of OECD countries Intervention Implementation of a cost containment policy Comparator Comparison over time, between regions or
3.2 Materials and methods
Table 3.1: PICOS inclusion criteria
between groups of insured Outcome Reduction in level or growth of:
Study design Empirical policy evaluations
Total expenditure
Sector expenditure
Public expenditure
Total health insurance premiums
Using inductive pilot searches, relevant keywords were defined for all inclusion criteria. A twofold strategy was employed: a search for cost-containment policies in general and a specific search for individual policies that were identified as cost-containment policies (Stadhouders et al., 2016). The final search string (see Appendix table 3.3), was amended with database specific glossary terms (MeSH terms). The following databases were searched (June 2016): Pubmed, Medline, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science and Econlit. After adding relevant articles from a second cost-containment literature database (Stadhouders et al., 2016), 7209 unique articles were collected. After excluding irrelevant articles based on title and abstract, 276
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