Page 53 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Effective healthcare cost-containment policies: a systematic review
in managed networks or that pharmaceutical adherence was better guarded by these plans (Hillman et al., 1999).
Prior authorisation policies and utilisation review policies may contain costs by reducing overtreatment. A review on prior authorisation (6 studies) found drug-related cost savings (MacKinnon and Kumar, 2001). One study demonstrated that drug utilisation review programs reduced total drug expenditures by 7% (Moore et al., 2000). According to a recent review (6 studies), prescription caps contain expenditures. However, access to essential drugs may decrease (Lee et al., 2015).
Mixed results were found for benefit restrictions. One review (9 studies) on prescribing restrictions found either lower costs (6 studies), no significant effect (2 studies), or even higher costs (1 study) (Green et al., 2010). A second review (30 studies) found that reimbursement restrictions predominantly contain costs but could lower patient outcomes (Lee et al., 2015). A third review (12 studies) on benefit restrictions found no effect on total costs, primarily due to substitution towards other therapies (Soumerai et al., 1993). A fourth review (59 studies) on managed care formulary restrictions found policies to be effective in 34%, neutral in 37% and ineffective in 29% of the studies (Happe et al., 2014). One additional study from South Korea found no significant effects after delisting certain drugs (Park et al., 2016).
The effectiveness of patient education to limit demand is also mixed. A review (2 studies) found no cost savings after a patient education program in Spain; in North America direct-to-consumer advertisements to reduce use of certain specific drugs even increased expenditures for these drugs (Lee et al., 2015). However, a randomised health promotion intervention for enrolees of a large Californian health plan, consisting of health assessments, education material and participant motivation, reduced claims by $3.2 to $8.0 million, between 1989 and 1991 (Fries et al., 1994).
We found 22 interventions from 16 studies and 6 reviews (101 studies) aiming to adjust market structure to contain costs. Most studies target payer structure, e.g. by stimulating use of managed care organizations (MCOs).
Market structure policies
Earlier studies showed predominantly cost-containing effects of MCOs. A 10% increase in MCO market penetration reduced premium growth by 7% (Feldstein and Wickizer, 1995). MCOs were estimated to have between 8% and 15% lower costs in competitive regional markets (Bamezai, 1999). Higher MCO market penetration led to annual hospital savings of 7% in California (Robinson, 1991). MCO penetration seems to have spillover effects; a 1% increase in MCO market share is associated with a 0.9%
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