Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators

Galiën, Onno van der; Berg, Bert van den

doi:10.1002/hec.3158

Cited by 8 publications

(13 citation statements)

References 41 publications

(38 reference statements)

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“…This interpretation is consistent with recent work conducted by Cutler, Skinner, Stern, and Wennberg () and Finkelstein et al () who found that patient demand is not as important in explaining regional variations in health care expenditures and that the organization of care and providers' behavior play a major role. Such an interpretation concurs with studies, such as that performed by Portrait, van der Galiën, and Van den Berg (), who showed that in the Netherlands, substantial heterogeneity exists between diabetes care groups' performances as measured using multidimensional indicators of quality and costs. Brekke, Holmås, Monstad, and Straume () attempted to understand the source of this variation.…”

Section: Discussionsupporting

confidence: 90%

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

et al. 2020

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The aim of this study was to document the extent to which diabetic patients who adhered to required medical follow‐ups in France experienced reduced hospital admissions over time. The main assumption was that enhanced monitoring and follow‐up of diabetic patients in the primary care setting could be a substitute for hospital use. Using longitudinal claim data of diabetic patients between 2010 and 2015 from MGEN, a leading mutuelle insurance company in France, we estimated a dynamic logit model with lagged measures of the quality of adherence to eight medical follow‐up recommendations. This model allowed us to disentangle follow‐up care in hospitals from other forms of inpatient care that could occur simultaneously. We found that a higher adherence to medical guidance is associated with a lower probability of hospitalization and that the take‐up of each of the eight recommendations may help reduce the rates of hospital admission. The reasons for the variation in patient adherence and implications for health policy are discussed.

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Section: Discussionsupporting

confidence: 90%

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

et al. 2020

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“…Hospital quality, Q i , is the final variable in the cost equations. Prior research by Portrait et al () supports a positive expectation regarding the sign of this variable. Lastly, C i ( CQ i ) is expected to retain a positively signed coefficient estimate in the pricing equations, as hospitals of all types are expected to engage in some degree of markup.…”

Section: Data and Econometric Modelsmentioning

confidence: 73%

“…Using the Dutch experience with managed competition, Portrait, Galiën, and van den Berg () develop a strategy to assess the relative performance of health care providers using data on quality and costs . Using a sample of 2,409 clients from about 20 diabetes care groups, these researchers conduct “a cost‐consequences analysis” suggesting that the link between quality of care and costs is ambiguous, as improvement in the quality of diabetes care is found to accompany either lower or higher costs (Portrait et al, ). This study is particularly relevant to the current research, given that we examine the impact of hospital quality on the costs of various medical procedures.…”

Section: Prior Literature: a Brief Reviewmentioning

confidence: 99%

Ownership structure and hospital service costs and fees: A decomposition approach

2018

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This paper analyzes hospital characteristics that are associated with higher average costs and charges for venipuncture, computed tomography procedures (computerized axial tomography [CAT] scans), and electrocardiograms (EKG). Using data from a Medicare database, our results indicate that higher wages, larger hospital sizes, and greater service quality are associated with higher procedure costs, whereas system membership is generally associated with lower procedure costs. Blinder‐type decompositions, which are the main focus of this study, suggest (a) that venipuncture costs are about 17% to 19% lower at proprietary hospitals than at nonprofit or government hospitals, (b) CAT scan costs are about 6% to 12% lower at nonprofit hospitals than at proprietary and government hospitals, and (c) that EKG costs are about 3% lower at proprietary hospitals than at nonprofit or government hospitals. Lastly, large portions of each of these differences are found to be due to both differences in mean values of the hospitals' characteristics by ownership type and differences in the mechanism by which the hospitals' characteristics are transmitted to procedure costs.

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“…We used 2008 and 2012 Diagnosis-based Cost Groups (DCGs), which are cost-profiles of the diseases based on diagnosis information [ 21 ] and PCGs from the Dutch risk equalization model [ 19 ], each referring to data from previous years. Using claims data from previous years may tackle the endogeneity issues that arise when using spending and health data from the same year [ 22 ]. The DCG variable ranged from 0 to 13 or 15 (13 clusters for 2008 and 15 for 2012) where a higher DCG number is equal to being in a higher cost cluster.…”

Section: Methodsmentioning

confidence: 99%

Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseases

Vries

Heijink

Struijs

et al. 2018

BMC Health Serv Res

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BackgroundTo indicate inefficiencies in health systems, previous studies examined regional variation in healthcare spending by analyzing the entire population. As a result, population heterogeneity is taken into account to a limited extent only. Furthermore, it clouds a detailed interpretation which could be used to inform regional budget allocation decisions to improve quality of care of one chronic disease over another. Therefore, we aimed to gain insight into the drivers of regional variation in healthcare spending by studying prevalent chronic diseases.MethodsWe used 2012 secondary health survey data linked with claims data, healthcare supply data and demographics at the individual level for 18 Dutch regions. We studied patients with diabetes (n = 10,767) and depression (n = 3,735), in addition to the general population (n = 44,694). For all samples, we estimated the cross-sectional relationship between spending, supply and demand variables and region effects using linear mixed models.ResultsRegions with above (below) average spending for the general population mostly showed above (below) average spending for diabetes and depression as well. Less than 1% of the a-priori total variation in spending was attributed to the regions. For all samples, we found that individual-level demand variables explained 62-63% of the total variance. Self-reported health status was the most prominent predictor (28%) of healthcare spending. Supply variables also explained, although a small part, of regional variation in spending in the general population and depression. Demand variables explained nearly 100% of regional variation in spending for depression and 88% for diabetes, leaving 12% of the regional variation left unexplained indicating differences between regions due to inefficiencies.ConclusionsThe extent to which regional variation in healthcare spending can be considered as inefficiency may differ between regions and disease-groups. Therefore, analyzing chronic diseases, in addition to the traditional approach where the general population is studied, provides more insight into the causes of regional variation in healthcare spending, and identifies potential areas for efficiency improvement and budget allocation decisions.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3128-4) contains supplementary material, which is available to authorized users.

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Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators

Cited by 8 publications

References 41 publications

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

Adherence to medical follow‐up recommendations reduces hospital admissions: Evidence from diabetic patients in France

Ownership structure and hospital service costs and fees: A decomposition approach

Unraveling the drivers of regional variation in healthcare spending by analyzing prevalent chronic diseases

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