Page 62 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Chapter 3
bias due to self-selection into the program of patients and organisations that have a high propensity to obtain a positive effect. Therefore, the actual implementation of proven concepts of care coordination to other settings may be challenging (Hoogendijk, 2016). Targeting the intervention to patients with high potential benefits may improve effectiveness. Furthermore, case management often comes with substantial upfront costs (Bloem et al., 2017). Although politically appealing, this strategy faces difficult implementation barriers on a short horizon with many different steps and is often highly dependent on specific local conditions.
Most studies show mixed and context-dependent results. For example, payment reforms are often thought to have substantial cost saving potential (Hussey et al., 2009). However, no such effect was found consistently, suggesting that payment schemes should be designed with great care to prevent undesirable provider responses and to sort out positive effects on costs and quality. Evidently, policies are interconnected and embedded in a broader health system and some may be reinforced or counteracted by other policies (Liu, 2003). For example competition: under certain conditions, competition may contain costs and specific types of payers (e.g. MCOs) may reinforce this; however, a higher penetration of for-profit providers may lead to higher costs. Moreover, the effect of competition, profit status or payer types may depend on the payment system in place. Mapping policy interrelations and institutions should be an important part of future research on this topic. The adoption of cost-containment policies likely depends on other policy goals such as quality of care, equity and efficiency. In many instances, the pursuit of a cost-containment strategy may come at the cost of one or more of these goals. This would require balance of cost-containment efforts with other important health system goals. Future research should inquire into policy outcomes on all relevant policy metrics and design combinations that sort out an optimal effect.
We collected evidence on the effectiveness of cost-containment policies from a payer perspective, and included 43 original studies and 18 systematic reviews evaluating 72 different cost-containment policies. We compared policy evaluations to policies identified in the literature. Of the 41 groups of cost containment policies, 21 were not evaluated, and even within the remaining groups several policies remain unevaluated. The existing evidence shows that the effectiveness of cost containment policies varies greatly between policies, underlining the need for evidence. Future policy evaluations should focus on the effectiveness of fee schedules, wage controls, capacity controls, prevention and reductions in administrative costs. Special attention should be given to the payer and societal
54
3.5 Concluding remarks