The relations between business model efficiency and novelty, and outcome while accounting for managed competition contract: a quantitative study among Dutch physiotherapy primary healthcare organisations

Abstract

Background Since 2006, business principles have been introduced to foster efficient healthcare by way of managed competition. Managed competition is expressed by a contract between a health insurer and a physiotherapy primary healthcare organisation (PTPHO). In such a managed environment, PTPHOs have to attain treatment service quality and financial PTPHO-centred outcomes Research shows that business model designs may enhance organisation-centred outcomes. A business model is a design (efficiency or novelty) of how a firm transacts with customers, partners, and vendors; how it connects with markets. However, research on managed competition contract and business model designs, in relation to PTPHO-centred outcomes is new to the healthcare literature. PTPHOs may not know how business model designs enhance outcomes. This study aims to delineate the relations between business model efficiency and novelty, and PTPHO-centred outcomes, while accounting for managed competition contract in Dutch healthcare. Methods A quantitative cross-sectional design was adopted. Using a questionnaire, the relations between managed competition, business model efficiency and novelty, and PTPHO-centred outcomes were investigated among PTPHO managers (n = 138). Theory-based expectations were set up and multiple linear regression analyses were applied. Results Managed competition and business model efficiency show no relation with PTPHO-centred outcomes. Moderation of the business model efficiency and PTPHO-centred outcomes relation by managed competition contract is not detected. Business model novelty shows a positive relation with PTPHO-centred outcomes. Moderation of the business model novelty and PTPHO-centred outcomes relation by managed competition contract is found. Conclusions There seem to be positive relations between business model novelty and PTPHO-centred outcomes on its own and moderated by managed competition contract. No relations seem to exist with business model efficiency. This implies that the combination of persistent use of health insurer-driven managed competition contracts and a naturally efficient PTPHOs may have left too few means for these organisations to contribute to healthcare reforms and attain PTPHO-centred outcomes. Organisation-driven innovation could stretch system-level regulations and provide room for new business models. Optimising contracts towards organisation-driven healthcare reform, including novelty requirements and corresponding reimbursements is suggested. PTPHO managers may want to shift their attitudes towards novel business models.

Public-private partnership models for rehabilitation service delivery: A scoping review

“…Of the nine included studies, approximately 56% ( n = 5) were from Australia (Farquhar, Moran & Schmidt 2020 ; Schmidt & Dmytryk 2014 ) and the remainder 44% ( n = 4) from Hong Kong (Schoeb 2016 ), Denmark (Larsen, Aust & Høgelund 2017 ), Bangladesh (Al Imam et al 2022 ) and the Netherlands (Ijntema et al 2022 ) with a study each. Qualitative study designs were mostly retrieved (44%).…”

“…All included studies focused on physiotherapy services. The PPP models discussed by these included studies were as follows: business model (Al Imam et al 2022 ; Carr, Kidd & Maloney 2013 ; Farquhar et al 2020 ; Ijntema et al 2022 ), informal PPP recruitment model (Schmidt & Dmytryk 2014 ), new graduate physiotherapists’ education PPP model (Schmidt & Dmytryk 2017 ), individual funding (IF) model (Dew et al 2013 ), social health model (Schoeb 2016 ) and Falck’s rehabilitation model (Larsen et al 2017 ). The services provided varied and primarily targeted all individuals requiring physiotherapy ( Table 1 ).…”

“…Of the nine included articles in the review, four from Australia reported research findings that involved a business model (Carr et al 2013 ; Farquhar et al 2020 ), Bangladesh (Al Imam et al 2022 ), and the Netherlands (Ijntema et al 2022 ).…”

“…In the Netherlands, Ijntema et al ( 2022 ) delineated the relationships between business model efficiency and novelty and physiotherapy primary healthcare organisation (PTPHO)-centred outcomes in Dutch healthcare while accounting for managed competition contracts (Ijntema et al 2022 ). The study showed that managed competition and business model efficiency do not affect PTPHO outcomes (Ijntema et al 2022 ). The managed competition contract does not appear to moderate the business model efficiency and PTPHO-centred outcomes relationship (Ijntema et al 2022 ).…”

“…The study showed that managed competition and business model efficiency do not affect PTPHO outcomes (Ijntema et al 2022 ). The managed competition contract does not appear to moderate the business model efficiency and PTPHO-centred outcomes relationship (Ijntema et al 2022 ). Business model novelty correlates positively with PTPHO-centred outcomes (Ijntema et al 2022 ).…”