Page 57 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Effective healthcare cost-containment policies: a systematic review
According to theory, structure and conduct of the market determine the market outcome (Martin, 2010). However, health sector performance can be improved irrespective of market structure and conduct by targeting inefficiencies outside the primary health production process, like reducing administrative costs, waste or fraud. Of all policies targeting non- health costs, only evaluations of health IT and tort reform were found. A literature review on health IT adoption, such as electronic health records, computerised physician order entry, and clinical decision supports, found cost-containment effects, specifically administrative costs and pharmaceutical expenses, in 43 out of a total of 57 evaluations (H. Low et al., 2013). Tort reform has been shown to decrease defensive medicine and liability premiums, lowering expenditure in the US by 2%-4% (Avraham et al., 2012; Hellinger and Encinosa, 2006).
Market performance policies
Although interventions were very heterogeneous, some general trends are visible. We found evidence that cost sharing contained total health expenditure (Bundorf, 2016; Feldstein and Wickizer, 1995) as well as pharmaceutical expenditure (Hillman et al., 1999; Joyce et al., 2002; Lee et al., 2015; Soumerai et al., 1993). Evaluations of case management interventions predominantly showed cost savings (Hawkins et al., 2015; Muller and Baker, 1996; Ozminkowski et al., 1999; Phillips et al., 2014). However, most of these programs do rely on voluntary participation by patients, thus risking selection bias. Insurer competition has been found to contain costs in California (Melnick and Zwanziger, 1988, 1995; Mobley, 1998b). Furthermore, unnecessary treatments may be reduced by prior authorisation (MacKinnon and Kumar, 2001) and utilisation review (Moore et al., 2000). Controlling access to care, e.g. by caps on the number of prescriptions (Lee et al., 2015), could also help to contain pharmaceutical expenditure. Lastly, price limits and budgets may also be effective in containing total payer expenses (Bazzoli et al., 2005; Huckfeldt et al., 2014; Nguyen, 1996; Sturm et al., 2007).
3.3.2. Synthesis
Other policies show more contradicting results. Payer structure policies for example, specifically those promoting managed care organizations, has shown to either lower costs (Bamezai, 1999; Chernew et al., 2008; Feldstein and Wickizer, 1995; Reich et al., 2012a; Robinson, 1991), increase costs (Ehlert and Oberschachtsiek, 2014) or have no effect on costs (Burns, 2009; Harman et al., 2011). Payment reform and prospective payments in some cases seem to lower costs (Bloom et al., 2011; Lemak et al., 2015; Reich et al., 2012a) but in other instances they increase costs (Gosden et al., 2000; Huckfeldt et al., 2014) or
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