Ontwikkelingen in zorginkoop: van inkoop van verrichtingen naar inkoop van zorgbundels

Abstract

Zorgverzekeraars en zorgaanbieders maken meestal contractafspraken op basis van een vergoeding per verrichting. Dat stimuleert echter volume van zorg in plaats van uitkomsten. Daarom passen zorgverzekeraars en zorgaanbieders steeds vaker ‘bundelinkoop’ als bekostiging toe. Dan wordt een bedrag per patiënt afgesproken. We beschrijven wat bundelinkoop is en introduceren de contractelementen. De impact van zorgbundels is dat ze door een andere verdeling van (financiële) verantwoordelijkheden uitkomsten centraal stellen, schotten doorbreken en innovatie stimuleren. Opschalen van deze methode van zorginkoop vraagt om standaardisatie van de contractelementen en uniformiteit van de bundeldefinitie per aandoening anders nemen de administratieve lasten voor zorgaanbieders toe.

How Can a Bundled Payment Model Incentivize the Transition from Single-Disease Management to Person-Centred and Integrated Care for Chronic Diseases in the Netherlands?

“…A more fundamental question that arises is whether a population-based payment model that would extend to the entire population in a geographically defined area (e.g., a region) and all care providers within that area would not be a more appropriate alternative compared to the alternative payment model proposed here. Especially, because that would stimulate prevention of disease and network care for the entire population in the catchment area, all of which is paid for from one bundled budget [50]. On one hand, it could fit the integrated nature of the PC-IC programme, but on the other hand, the step from the currently used bundled payments to a population-based payment might be too big.…”

“…This increases mutual responsibility. One of the perverse incentives of a bundled payment that may not cover the full care path of a patient, is that patients are referred to services outside the bundle [50]. The shared savings model mitigates this perverse incentive because the comparison of the actual and the expected expenditure (i.e., the virtual budget) pertains to the total healthcare expenditure.…”

Factors Influencing Procurement of Digital Health Care: A Case Study in Dutch District Nursing

“…27,28 The systematic approach of the framework analysis, as suggested King and Brooks and Gale et al provides rigour and clarity in the analysis. 27,28 Based on the first round of literature search, as described under the data collection section, we used literature on public procurement of innovation, 29 telehealth service implementation frameworks 30,31 and payment models 32,33 to develop a preliminary category system. We followed the recommendation to keep this relatively simple at this stage.…”

“… 35 Dutch healthcare purchasing is mostly transaction oriented, using price and volume-based payment models (such as fee-for-service). 32 , 36 Its governance is managerial, financial results are needed on short-term(yearly) to keep insurance fees low, and organisations strive for economies of scale. 16 , 35 …”

“…35 Dutch healthcare purchasing is mostly transaction oriented, using price and volume-based payment models (such as fee-forservice). 32,36 Its governance is managerial, financial results are needed on short-term(yearly) to keep insurance fees low, and organisations strive for economies of scale. 16,35 The factors related to sustained funding of digital health we identified in the setting of Dutch district nursing are however rather common, also seen from an international perspective.…”