Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands

Heijink, Richard; Mosca, Ilaria; Westert, Gert P.

doi:10.1016/j.healthpol.2013.06.003

Cited by 12 publications

(20 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few studies look at the relationship between price and quality variation or between hospital concentration and quality after prices were liberalized. Heijink et al (2013) find only limited variation in hospital quality and no relationship between contract prices and quality for cataract care. Croes et al (2017) We construct a hospital-level panel which includes information on quality of care and patient case mix, and supplement this with an index of socio-economic status that is averaged over all the non-acute hip replacement patients of a hospital in a given year.…”

Section: Price Competition In the Dutch Healthcare Marketmentioning

confidence: 76%

Does Price Competition Damage Healthcare Quality?

et al. 2018

View full text Add to dashboard Cite

One of the reasons why regulators are hesitant about permitting price competition in healthcare markets is that it may damage quality when information is poor. Evidence on whether this fear is well-founded is scarce. We provide evidence using a reform that permitted Dutch health insurers and hospitals to freely negotiate prices for elective procedures. Unlike previous research that has relied on indicators of the quality of urgent treatments, we take advantage of the plausible absence of selection bias in our setting to identify the effect on quality of non-acute hip replacements. Using administrative data on all admissions to Dutch hospitals, we find no evidence that increased exposure to price competition reduces quality measured by readmission rates, despite the lack of publicly available information on this outcome. In fact, there is evidence of a temporary, positive impact on quality. Our estimated null effect over the full post-liberalization period is robust.

show abstract

Section: Price Competition In the Dutch Healthcare Marketmentioning

confidence: 76%

Does Price Competition Damage Healthcare Quality?

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The Dutch government has asked the Health Inspectorate to develop quality indicators. We need to wait for reliable quality indicators to see the impact of competition on health care quality (Bijlsma et al 2010;Heijink et al 2013). Also, further research is necessary to analyze the different effects of competition on substitution patterns between inpatient and outpatient care.…”

Section: Discussionmentioning

confidence: 99%

“…Most research relies on proxies for costs, like charges and length of stay, both of which have severe drawbacks (Botz et al 2006;Evans et al 2007;Martin and Smith 1996;Schreyögg et al 2011). Previous research on the Dutch situation has focused on inpatient treatments or on one specialty/surgery only (Heijink et al 2013). We contribute to the existing literature on the introduction of managed competition by analyzing the change in overall production in The Netherlands, taking into account local variations in the spatial concentration of hospitals, insurers and ITCs simultaneously.…”

Section: Concentration Of Payers As In the Us Preferred Providermentioning

confidence: 99%

“…In 2005, the Dutch government introduced managed health care competition with limiting conditions for liberalization and strong supervision (Schut and Van de Ven 2005). This type of competition was expected to lead to more transparency, more demand-driven competition, higher quality and more cost containment in the health care sector (Heijink et al 2013;Heinemann et al 2013;Ministry of Health 2001). Cost containment was particularly to be achieved by a performance-based reimbursement system for a dedicated part of the total hospital production of elective care products.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The impact of hospital competition and insurer concentration on health care volume and cost in Dutch hospitals

Krabbe-Alkemade¹,

Groot²,

Boter³

2019

MAB

View full text Add to dashboard Cite

This study analyses the effect of spatial concentration of general hospitals, the appearance of independent treatment centers (in Dutch: Zelfstandige Behandelcentra: ZBCs) and the concentration of health insurers on production volume and costs since the introduction of market-oriented health care reforms in the Netherlands. We use regression analyses of 1,345,144 patient-level hospital data for fifteen major diagnosis treatment combinations (in Dutch: Diagnose Behandeling Combinaties: DBCs), representing 70% of the managed competition segment (the so-called B-segment). We find that spatial concentration of hospitals and concentration of insurers do not affect health care production volume. More competitive hospital markets are associated with higher cost of most DBCs studied. Surprisingly, hospitals operating under insurers with high monopsonic power incur higher average DBC-cost than hospitals operating under insurers with more dispersed power. The number of independent treatment centers in the hospital’s vicinity is positively related to health care volume and average cost.

show abstract

“…They found a significant impact of idiosyncratic effects on hospital prices, which, as argued by the authors, is consistent with the fact that the Dutch hospital sector is not yet in a long-run equilibrium. Heijink et al (2013) studied a single hospital procedure (i.e. cataract surgery) and found evidence of substantial price variation that was persistent over time (from 2006 to 2009).…”

Section: Introductionmentioning

confidence: 99%

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

Douven

Burger

Schut

2019

HEPL

View full text Add to dashboard Cite

In the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.

show abstract

Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands

Cited by 12 publications

References 25 publications

Does Price Competition Damage Healthcare Quality?

Does Price Competition Damage Healthcare Quality?

The impact of hospital competition and insurer concentration on health care volume and cost in Dutch hospitals

Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

Contact Info

Product

Resources

About