Page 75 - Effective healthcare cost containment policies Using the Netherlands as a case study - Niek W. Stadhouders

Payment reform Gosden et al., (Capitation) 2000
SR (1 study) USA
One study was included finding higher total costs after replacement of 12/12
FFS with capitation for GPs.
Controlling for patient selection, capitating managed care contracts is Cv Sb Cb associated with 5.5% lower costs between 2006 and 2009. 1 2 2 Over a five year period (1995-1999) lower cost growth was found after Cv Sb Cb capitation, of which the first 2 significantly. The effect is 0.48% for for- 2 3 1 profit providers and 0.22% for non-profit providers.
Policy Paper
Method Country
Effect Assessment*
Payment reform Giuffrida et al., (Pay-for – 1999
SR (0 studies)
performance)
Emmert et al., 2012
Lemak et al., 2015
SR (9 studies)
Mb R 2 2 Mb R 1 2 Mb R 3 2 Mb R 1 2 Mb R 1 1
Payment reform Hsiao et al., 1987
multivariate panel USA OLS
2 stage probit USA simulated IV model Multivariate USA regression analysis Compare sample USA means
(DRG)
Payment reform Huckfeldt et al.,
(Prospective 2014
payment system)
Sloan et al. 1988 Feder et al., 1987
Health IT Tort reform
Low et al. 2013 Avraham et al., 2012
Hellinger et al., 2006
SR (57 studies) USA WLS panel USA estimation
Multivariate USA regression
43 of 57 included studies found cost savings of health IT applications. 8/12
Using state variation in timing of tort reforms between 1998 and 2006, Cv Sb Cb the authors estimate a 2.1% reduction in total costs due to tort reform. 2 3 1 Using state variation in tort reform laws (1984-1998), the authors Cv Sb Cb found tort reforms reduce costs by 3% to 4%. 2 2 2
Reich et al., 2012 Bloom et al., 2011
mixed model panel CHE analysis
Random effects USA estimation
No papers were found evaluating effectiveness of target payments on 9/12 total costs.
Of 9 included studies, 3 performed formal evaluations, finding no 9/12 significant effect on costs.
Mb R 3 2 Mb R 2 2
multilevel D-in-D USA
Physician P4P resulted in 1.1% cost savings and positive outcomes for Cv Sb Cb Michigan’s Blue Cross Blue Shield program from 2008 to 2011. 1 1 2 No significant effect on costs of replacement of per-diem payments Cv Sb Cb with DRG payments in New Jersey in 1980 was found. 2 1 3 PPS, implemented in 2000, increased home care costs slightly, in part Cv Sb Cb due to higher levels of payments. 1 2 3 The 1983 PPS-PRO program resulted in significant cost savings for Cv Sb Cb Medicare hospital costs. 3 2 3 PPS-paid hospitals had 3 percent point lower growth in 1984 total Cv Sb Cb expenses than hospitals paid under TEFRA. 1 1 3
Market performance policies
Mb R
* 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; Mb: measurement bias; R: reliability. Legend: 3=high quality, 2=mediocre quality, 1=low quality. Note: SR: systematic review; IV: instrumental variable; OLS: ordinary least squares; D-in-D: difference in differences; FFS: fee for service PPS: prospective payment system; P4P: pay for performance; CHE: Switzerland; NOR: Norway; BEL: Belgium; KOR: Korea; CAN: Canada; GER: Germany; SWE: Sweden; DEN: Denmark; ESP: Spain; POR: Portugal; GBR: United Kingdom, IER: Ireland, USA: United States of America; GP: general physician; PMPM: per member per month; ROI: return on investment; IT: information technology.
2 Mb 3
2 R 2