Page 58 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 3
have no effect on costs (Emmert et al., 2012; Giuffrida et al., 1999; Hsiao and Dunn, 1987). For-profit provision seems to increase expenses, although not consistently (Devereaux et al., 2004; Rosenau, 2003; Schlesinger et al., 1986). Despite the fact that many countries rely on benefit package restrictions to contain pharmaceutical expenditure, evidence did not consistently indicate cost savings (Green et al., 2010; Happe et al., 2014; Lee et al., 2015; Park et al., 2016; Soumerai et al., 1993).
To identify gaps in the literature, the results are plotted in the overview of cost-containment policies by Stadhouders et al. (2016). Figure 3.1 shows that no evaluations were found in 21 of 41 categories. For price controls, evidence on fee schedules and price negotiations is lacking. Regarding supply side volume controls, we found no evidence for capacity controls, such as limits on the number of beds or the number of providers through certificate-of- needs policies, or for labour restrictions, such as limiting the number of practitioners. For demand controls, no evidence evaluating the effects of prevention on a payer level has been included. Additionally, no evaluations of policies limiting the pace of costly innovations were found. In the category of market structure policies, we were unable to include evaluations of antitrust policy, such as merger controls, or risk redistribution, such as risk equalisation programs. No evaluations were found on the effects of consumer choice, contracting policies or patient choice in the category of market conduct policies. Lastly, no papers were included on administrative reductions, fraud control, waste reduction programs, managerial improvement policies, transparency increases or cost-reducing innovations.
3.3.3. Identification of knowledge gaps
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