Abstract:This paper evaluates the impact of market competition on health care volume and cost. At the start of 2005, the financing system of Dutch hospitals started to be gradually changed from a closed-end budgeting system to a non-regulated price competitive prospective reimbursement system. The gradual implementation of price competition is a ‘natural experiment’ that provides a unique opportunity to analyze the effects of market competition on hospital behavior. We have access to a unique database, which contains h… Show more
“…In addition, using a macro budget (i.e. budget restriction on national healthcare expenditure) was suggested as an option to overcome this problem.If, for example, patients go to the GP more often, perhaps the time for the complex dermato‐oncological patient should, perhaps they should also get more time, so that they are better looked at, and that it in any case doesn't lead to losses. (Dermatologist 9)It is like if you run a red light and you don't get a ticket you keep running red lights, and if you are not punished for it, you just keep doing your own thing.…”
SummaryBackgroundProviding follow‐up to patients with low‐risk basal cell carcinoma (BCC) can be considered as low‐value care. However, dermatologists still provide substantial follow‐up care to this patient group, for reasons not well understood.ObjectivesTo identify factors influencing current BCC follow‐up practices among dermatologists and suggested strategies to de‐adopt this low‐value care. In addition, views of patients regarding follow‐up care were explored.MethodsA qualitative study was conducted consisting of 18 semistructured interviews with dermatologists and three focus groups with a total of 17 patients with low‐risk BCC who had received dermatological care. The interviews focused on current follow‐up practices, influencing factors and suggested strategies to de‐adopt the follow‐up care. The focus groups discussed preferred follow‐up schedules and providers, as well as the content of follow‐up. All (group) interviews were transcribed verbatim and analysed by two researchers using ATLAS.ti software.ResultsFactors influencing current follow‐up care practices among dermatologists included complying with patients’ preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow‐up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de‐adopt the low‐value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realizing appropriate financial reimbursement and informing dermatologists about the low value of care.ConclusionsA mixture of factors appear to contribute to current follow‐up practices after low‐risk BCC. In order to de‐adopt this low‐value care, strategies should be aimed at dermatologists and GPs, and also patients.
“…In addition, using a macro budget (i.e. budget restriction on national healthcare expenditure) was suggested as an option to overcome this problem.If, for example, patients go to the GP more often, perhaps the time for the complex dermato‐oncological patient should, perhaps they should also get more time, so that they are better looked at, and that it in any case doesn't lead to losses. (Dermatologist 9)It is like if you run a red light and you don't get a ticket you keep running red lights, and if you are not punished for it, you just keep doing your own thing.…”
SummaryBackgroundProviding follow‐up to patients with low‐risk basal cell carcinoma (BCC) can be considered as low‐value care. However, dermatologists still provide substantial follow‐up care to this patient group, for reasons not well understood.ObjectivesTo identify factors influencing current BCC follow‐up practices among dermatologists and suggested strategies to de‐adopt this low‐value care. In addition, views of patients regarding follow‐up care were explored.MethodsA qualitative study was conducted consisting of 18 semistructured interviews with dermatologists and three focus groups with a total of 17 patients with low‐risk BCC who had received dermatological care. The interviews focused on current follow‐up practices, influencing factors and suggested strategies to de‐adopt the follow‐up care. The focus groups discussed preferred follow‐up schedules and providers, as well as the content of follow‐up. All (group) interviews were transcribed verbatim and analysed by two researchers using ATLAS.ti software.ResultsFactors influencing current follow‐up care practices among dermatologists included complying with patients’ preferences, lack of trust in general practitioners (GPs), financial incentives and force of habit. Patients reported varying needs regarding periodic follow‐up visits, preferred to be seen by a dermatologist and indicated a need for improved information provision. Suggested strategies by dermatologists to de‐adopt the low‐value care encompassed educating patients with improved information, educating GPs to increase trust of dermatologists, realizing appropriate financial reimbursement and informing dermatologists about the low value of care.ConclusionsA mixture of factors appear to contribute to current follow‐up practices after low‐risk BCC. In order to de‐adopt this low‐value care, strategies should be aimed at dermatologists and GPs, and also patients.
“…ITCs needed fewer revision surgeries after ACL surgery. In contrast, revision surgery after THR was performed more (14) Abbreviations: ITCs, independent treatment centres; CTS, carpal tunnel syndrome; ACL, anterior cruciate ligament.…”
Section: Discussionmentioning
confidence: 99%
“…Since then, consumers have been able to freely choose their health insurers and healthcare providers. 14,15 In this regulated competition system, health insurers purchase healthcare selectively from different providers, and negotiate features, such as volume, price and quality. Insurers offer 2 types of plans: a benefits in-kind plan and a restitution plan.…”
Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods: The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results: Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions: This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery.
“…This supports our findings. However, the authors also found a drop in average costs for outpatient care (Krabbe-Alkemade et al 2017). Therefore, there might be a difference in how the two sectors were affected by the reforms.…”
Section: Discussionmentioning
confidence: 93%
“…Using DEA-methods, Van Ineveld et al (2015) found that productivity declined significantly in the years 2008-2009 and 2009-2010, but due to the methodology used, causation between deregulation and the productivity loss could not be established. On a restricted database of four specialties, Krabbe-Alkemade et al (2017) evaluated the changes in product volumes, total and average costs of care and the number of activities as a result of the transfer between A-and B-segment in 2008. Similarly to our paper, the variables total and average cost of care were calculated by multiplying the number of registered activities times the average value per activity.…”
Deregulation and the related rise in competition are generally believed to spur productivity growth. This relationship is one of the main arguments used for the liberalization of healthcare industry. But the exceptional nature of healthcare markets, the presence of asymmetric information and physician-induced demand casts doubt on whether this also holds for the provision of care. Using the healthcare reform of 2006 in the Netherlands, we evaluated how productivity changed when the market was opened to competition. Our results indicate that improvements in productivity were smaller after products were transferred to the liberalized-segment (by 9.5 and 6.6% in 2008 and 2009), suggesting a negative relationship between competition and productivity in healthcare. Our paper also shows that higher levels of productivity gains were reached using hospital budget financing compared to open competition. Competition in healthcare provision has several advantages, such as moderating the growth in product prices and improving patient-choice, but it is more susceptible to physician-induced demand. Meanwhile, budget financing has the advantage of boosting productivity, but the resulting economic gains are generally assumed by the provider. Therefore, we conclude that competition could be socially optimal if volumes and treatment activity could be effectively controlled, and likewise that budgets could be optimal if hospital savings earned through productivity gains could be passed on to society.
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