Page 71 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Policy Paper
Method
Country
Effect
Assessment*
Benefit package (formulary restrictions)
Lee et al. 2015
SR
(30 studies)
9/12
Benefit package Park et al., (delisting) 2016
Interrupted time series and D-in-D analysis
KOR
No significant effect of 2006 delisting policy on total costs was found.
Cv Sb Cb Mb R 32332
Patient Lee et al. 2015
SR
(2 stduies)
USA, NLD, ESP, NOR, AUS
USA
Patient education increased generic use, but did not reduce spending.
9/12
education
Fries et al.,
RCT means
A health promotion program for Blue Shield members reduced claims
Cv Sb Cb Mb R
Green et al. 2010
SR
(9 studies)
CAN, DEN, USA, BEL, NOR
USA, NLD, ESP, NOR, AUS
6 studies found lower costs due to drug restrictions, 2 studies found no significant effect on costs. 1 study found lower costs after relaxation of drug prescribing restrictions.
Reimbursement restrictions may lower spending, but could affect quality negatively.
10/12
Soumerai et al., 1993 Happe et al. 2014
SR
(12 studies) SR
(59 studies)
USA USA
Reductions in the benefit package may have no effect on costs due to substitution.
Economic outcomes of formulary restrictions contained costs in 34% of the cases, increased costs in 29% and were neutral in 37%. For clinical outcomes this was respectively 3%, 68% and 28%.
7/12 4/12
1994
* For assessment scores, see appendix 3.1. Fractions indicate scores on the AMSTAR review scale (table 3.2). Cv: content validity, Sb: Selection bias; Cb: confounding bias;
comparison
costs by $3.2 to $8.0 million between 1989 and 1991.
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Mb: measurement bias; R: reliability. Legend: 3=high quality, 2=mediocre quality, 1=low quality
Note: CDHP: Consumer directed health plan; SR: systematic review; IV: instrumental variable; OLS: ordinary least squares; D-in-D: difference in differences; USA: United States of America; NOR: Norway; BEL: Belgium; KOR: Korea; CAN: Canada; SWE: Sweden; DEN: Denmark; HMO: Health maintenance organization; IPA: independent practice association; CDHP: consumer-directed health plan.