Page 72 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Market structure policies
Policy Paper Method Country Effect Assessment*
Purchasers Feldstein et al., Fixed effects USA (HMOs) 1995 model
A 10% increase in HMO market share reduces premium growth by 6.5% between 1985 and 1992.
Especially in competitive markets HMOs and PPOs lower health costs by at most 15.3% and 7.7%, respectively (1989-1994).
Cv Sb 2 2 Cv Sb 2 1 Cv Sb 1 1
Cb Mb R 2 2 2 Cb Mb R 2 1 3 Cb Mb R 1 2 2
Bamezai, 1999 First differences USA model
HMO penetration is estimated to have led to cost savings of over one billion in 1988, or 6.7% to 7.1% of total hospital costs.
Robinson, Varying USA 1991 parameter
regression
Chernew et al., Instrumental USA
Increase in HMO penetration (1994-2001) has cost-saving spillovers on FFS of 0.3% to 0.9% per one percent increase in penetration.
Cv Sb 2 1
Cb Mb R 3 2 3
2008 variable
estimation
Purchasers Harman et al., D-in-D USA
No significant difference found between Florida counties with high adoption and low adoption of Medicaid MCOs between 2004 and 2008.
For disability patients no significant differences between MCOs and traditional Medicaid were found between 1996 and 2004. Controlling for patient selection, managed care is associated with 15.5% lower costs between 2006-2009.
Cv Sb 2 3
Cb Mb R 2 2 3
(Medicaid MCOs) 2011
Cv Sb 1 2 Cv Sb 1 2
Cb Mb R 1 2 2 Cb Mb R 2 3 2
Burns, 2009 Two-part USA regression
Purchasers Reich et al., mixed model CHE (Managed care) 2012 panel analysis
with case-mix
correction
Ehlert et al., Random effects GER
A 1% increase in managed care contracts increased pharmaceutical expenditure in neighbouring regions. Total expenditure is increased by 0.2% to 0.8% (0.5-2 million euro) between 2004 and 2008.
Costs of mental care dropped 30%-40% after a 1993 carve-out.
Cv Sb 3 3
Cb Mb R 3 2 3
2014 panel estimation
Cv Sb 1 1 Cv Sb 1 2
Cb Mb R 2 2 2 Cb Mb R 2 3 2
Purchasers Ma et al., 1998 before-after USA (Mental health carve out) comparison
Providers (telemedicine) Reich et al., mixed model CHE
Controlling for patient selection, offering of telemedicine in managed care contracts is associated with 3.7% lower costs between 2006 and 2009.
2012 panel analysis
correction
Providers (Hospice care at Gozalo et al., OLS regressions USA
Costs decreased by 8% on average between 1998 and 1999, mainly driven by patients with cancer, while patients with dementia experienced no significant differences in costs, and other diagnoses experienced increased costs.
Cv 2
Sb 2
Cb Mb R 2 2 2
end-of-life) 2008
No evidence was found on which type of rehabilitation care is most 7/12 cost effective.
Providers (rehabilitation Ward et al. SR
care) 2008 (0 studies)
with casemix