Market Share and Price in Dutch Home Care: Market Power or Quality?

Mosca, Ilaria; Pomp, Marc; Shestalova, Victoria

doi:10.1007/s10645-010-9137-2

Cited by 8 publications

(5 citation statements)

References 11 publications

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“…Literature on provider concentration finds mixed results. [30][31][32][33] Depending on which effect dominates, provider concentration could result in differences in the baseline level of MAI between sectors. Therefore, we research the relation between reallocations and provider size in the previous year, both in absolute terms and in relative terms.…”

Section: Trend Analysis and Explanatory Regression Analysismentioning

confidence: 99%

“…We find that provider concentration is associated with higher reallocations, consistent with some but not all literature. [30][31][32][33] Managed competition has been advocated to constrain total costs, although this was not the main objective of the 2007 competitive reform. 20,67 If insurers pursue cost containment under managed competition uniformly, this could be reflected in a low MAI.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

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

Stadhouders,

Koolman,

Tanke

et al. 2023

Int J Health Policy Manag

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Background: Purchasing systems aim to improve resource allocation in healthcare markets. The Netherlands is characterized by four different purchasing systems: managed competition in the hospital market, a non-competitive single payer system for long-term care, municipal procurement for home care and social services, and self-procurement via personal budgets. We hypothesize that managed competition and competitive payer reforms boost reallocations of provider market share by means of active purchasing, i.e. redistributing funds from high-quality providers to low-quality providers. Methods: We define a Market Activity Index (MAI) as the sum of funds reallocated between providers annually. Provider expenditures are extracted from provider financial statements between 2006 and 2019. We compare MAI in six healthcare sectors under four different purchasing systems, adjusting for reforms, and market entry/exit. Next, we perform in-depth analyses on the hospital market. Using multivariate linear regressions, we relate reallocations to selective contracting, provider quality, and market characteristics. Results: No difference was found between reallocations in the hospital care market under managed competition and the non-competitive single payer long-term care (MAI between 2% and 3%), while MAI was markedly higher under procurement by municipalities and personal budget holders (between 5% and 15%). While competitive reforms temporarily increased MAI, no structural effects were found. Relatively low hospital MAI could not be explained by market characteristics. Furthermore, the extent of selective contracting or hospital quality differences had no significant effects on reallocations of funds. Conclusion: Dutch managed competition and competitive purchaser reforms had no discernible effect on reallocations of funds between providers. This casts doubt on the mechanisms advocated by managed competition and active purchasing to improve allocative efficiency.

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Section: Trend Analysis and Explanatory Regression Analysismentioning

confidence: 99%

Section: Strengths and Limitationsmentioning

confidence: 99%

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

Stadhouders,

Koolman,

Tanke

et al. 2023

Int J Health Policy Manag

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“…The purpose of this reform was to introduce incentives for higher cost‐efficiency and to create quasi‐markets (Bartlett & Le Grand 1993). However, it has been shown that this mechanism had hardly any effect on lowering the prices, mainly owing to the dominant market power of a few providers in each region (Mosca et al. 2010).…”

Section: New Discourse and Normative Principles Underlying Cost Contamentioning

confidence: 99%

“…The purpose of this reform was to introduce incentives for higher cost-efficiency and to create quasi-markets (Bartlett & Le Grand 1993). However, it has been shown that this mechanism had hardly any effect on lowering the prices, mainly owing to the dominant market power of a few providers in each region (Mosca et al 2010). Most traditional home-care organisations still hold quasi-monopolist positions; mergers have been quite common since the early 2000s; and the entrance of new and small providers into the market has been limited (RVZ 2003, Kremer 2006.…”

Section: Cost Containment and Quasi-markets As A Regulatory Mechanismmentioning

confidence: 99%

The Netherlands: the struggle between universalism and cost containment

Roit

2012

Health &Amp; Social Care in the Community

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The Dutch home-care system is embedded in a universalistic and comparatively generous long-term care (LTC) scheme that was introduced in the late 1960s. The tension between guaranteeing access to good-quality care and controlling costs has been a key issue since the inception of the LTC scheme. The article addresses the question of how these two distinct objectives have been dealt with in the political debate and by policy-making in the past 20 years. It does so by looking at existing studies, official statistics and policy documents. First, the analysis shows that home care - the development of which results from the de-institutionalisation policies pursued since the 1980s - has shifted from being considered a cost-containment measure to representing a battlefield on cost containment. Second, the article argues that the issue of cost containment is a leitmotif in the development of home care that has been accompanied and legitimised over time by distinct normative views. On the one hand, traditional forms of cost containment - namely direct budgetary controls - have been predicated on the need to ensure the financial sustainability of the system and its universalistic features. On the other hand, the discourse and practice of cost containment has, since the early 1990s, also been accompanied by normative views that structurally challenge universalism through the introduction of new ideas about the responsibility for LTC risks, resource allocation and regulation of the system.

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“…In the home care sector, this has led prices to stay very close to the regulated maximum tariff. It has also undermined competition in the home care market, which is highly concentrated and where large providers have been able to charge higher prices (Mosca et al, 2007). The overall cost of these inefficiencies is hard to assess, but may be significant, as suggested by the substantial improvements in cost-efficiency following the decentralisation of home help to municipalities (Box 5).…”

Section: Box 4 a Comprehensive Public Long-term Care Systemmentioning

confidence: 99%