Do quality improvements in assisted reproduction technology increase patient numbers in a managed competition setting?

Abstract

Summary In a system of managed competition, selective contracting and patient choice reward providers for quality improvements through increases in patient numbers and revenue. We research whether these mechanisms function as envisioned by investigating the relationship between quality improvements and patient numbers in assisted reproduction technology in the Netherlands. Success rate improvements primarily reduce volume as fewer secondary treatments are necessary, but this can be compensated by attracting new patients. Using nationwide registry data from 1996 to 2016, we find limited evidence that high‐quality clinics attract new patients, and insufficiently as to compensate for the reduction in secondary treatments. The net effect of quality increases appears to be a small decline in revenue. Therefore, we conclude that patient choice and active purchasing reward quality improvements insufficiently. Nevertheless, clinics have improved quality drastically over the last years, showing that financial incentives are perhaps less important factors for quality improvements than factors such as intrinsic motivation and professional autonomy.

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

“…Studies on the relation between quality and selective contracting in the managed competition sector in the Netherlands are limited, and show mixed results. 56 - 58 Studies on price competition in the Dutch hospital-sector also show limited responsiveness of insurers to price differences. 14 , 15 , 59 One study found an increase in total costs of inpatient DRGs after the introduction of market-based price competition, but a decrease in total costs of outpatient DRGs.…”

Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands

“… 9 , 47 - 49 One potential explanation for these conflicting findings is that growth in the number of new patients may not correlate with growth in hospital expenditures, for example when prices or treatment intensity decline correspondingly. 50 Furthermore, it remains unclear whether active purchasing or patient choice drives these results. 43 , 50 Paradoxically, we found extensive differences in selective contracting between providers and over time, without any distinguishable effect on provider budgets.…”

“… 50 Furthermore, it remains unclear whether active purchasing or patient choice drives these results. 43 , 50 Paradoxically, we found extensive differences in selective contracting between providers and over time, without any distinguishable effect on provider budgets. Potential explanations include selective contracting having limited impact on patient flows, 51 with insurers required to (partially) reimburse noncontracted care, 17 hospitals levering market power to compensate reductions in income, 52 hospitals shifting costs between insurers as a response to selective contracting, 53 or insurers using selective contracting to concentrate care symmetrically between providers without affecting total expenditures.…”