Towards population-based payment models in a multiple-payer system: the case of the Netherlands

Remers, Toine E. P.; Wackers, Erik; Dulmen, Simone A. van; Jeurissen, Patrick

doi:10.1016/j.healthpol.2022.09.008

Cited by 7 publications

(3 citation statements)

References 39 publications

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“… 7 Furthermore, alignment of payers and providers through alternative payment models may be beneficial for increasing quality and reducing costs. 53 Moreover, global budgets were relatively successful in reducing healthcare utilisation in the Netherlands. 54 Existing case studies underline the importance of accurate and timely data to support change processes, 7 , 44 which seemed insufficiently acknowledged in the strategies of Bernhoven and the Beatrix hospital.…”

Section: Discussionmentioning

confidence: 99%

Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands

Wackers¹,

Dulmen²,

Berden³

et al. 2023

Int J Health Policy Manag

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Background: Hospital strategies aimed at increasing quality of care and simultaneously reducing costs show potential to improve healthcare, but knowledge on real-world effectiveness is limited. In 2014, two Dutch hospitals introduced such quality-driven strategies. Our aim was to evaluate contexts, mechanisms, and outcomes of both strategies using multiple perspectives. Methods: We conducted a mixed methods evaluation. Four streams of data were collected and analysed: (1) semi-structured interviewing of 62 stakeholders, such as medical doctors, nurses, managers, general practitioners and consultants; (2) financial statements of both organisations and other hospitals in the Netherlands (counterfactual); (3) national database of quality indicators, and patient-reported experiences; (4) existing material on strategy development and effects. Results: Both strategies resulted in a relative decrease in volume of care within the hospital, while quality of care has not been affected negatively. One hospital failed to cut operating costs sufficiently, resulting in declining profit margins. We identified six main mechanisms that impacted these outcomes: (1) Quality-improvement projects spur change and commitment; (2) increased coordination between hospital and primary care leads to substitution of care; (3) insufficient use of data and support hinder quality improvement; (4) scaling down hospital facilities is required to convert volume reductions to cost savings; (5) shared savings through global budgets lead to shared efforts between payer and hospital; and (6) financial security for physicians facilitates shift towards quality-driven care. Conclusion: This integrated analysis of mixed data sources demonstrated that the institutionwide nature of the strategies has induced a shift from a focus on production towards quality of care. Longer-term (financial) sustainability of hospital strategies aimed at decelerating production growth requires significant efforts in reducing fixed costs. This strategy poses financial risks for the hospital if operating costs are insufficiently reduced or if payer alignment is compromised.

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Section: Discussionmentioning

confidence: 99%

Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands

Wackers¹,

Dulmen²,

Berden³

et al. 2023

Int J Health Policy Manag

View full text Add to dashboard Cite

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“…Publicity and use platforms or channels such as official websites, Weibo, and WeChat should be augmented to increase public understanding of the hierarchical medical policy. Hospitals and patients should be guided to implement the policy through their economic behavior by further improving diagnosis-related groups [ 43 , 44 ], thus ensuring that high-level hospitals receive patients with severe and acute diseases and low-level hospitals receive patients with less severe diseases. In addition, we suggest that patients with chronic and common diseases be reimbursed for their medical expenses only when they receive their initial diagnosis and treatment at primary medical institutions.…”

Section: Discussionmentioning

confidence: 99%

Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China

2023

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Hierarchical medical policies are widely used worldwide to reduce healthcare costs, rationalize the use of healthcare resources, and improve accessibility and fairness of healthcare services. However, few case studies have evaluated the effects and prospects of such policies. Medical reform efforts in China have distinct goals and characteristics. Therefore, we investigated the effects of a hierarchical medical policy in Beijing and assessed the future potential of the policy to yield insights for other countries, especially developing countries. Different methods were used to analyze multidimensional data from official statistics, a questionnaire survey of 595 healthcare workers from 8 representative public hospitals in Beijing, a questionnaire survey of 536 patients, and 8 semi-structured interview records. The hierarchical medical policy had strong positive effects on improving access to healthcare services, balancing the workload of healthcare workers in various levels of public hospitals, and improving the management of public hospitals. The remaining obstacles include severe job stress among healthcare workers, the high cost of some healthcare services, and the need for improvement in the development level and service capacity of primary hospitals. This study provides useful policy recommendations regarding the implementation and extension of the hierarchical medical policy, including the need for governments to improve the hospital assessment system and for hospitals to actively participate in developing medical partnerships.

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“…All residents of the Netherlands are required to take out a standardized health insurance package ("basic health insurance") from one of several competing private health insurers. In 2022, there were 20 health insurers in the Netherlands, most of which belong to one of nine independent health insurance groups (Nederlandse Zorgautoriteit, 2022 [3]). The basic health insurance plan covers a comprehensive package of curative health services that is nationally standardised and includes care provided by GPs, hospital care, prescription drugs, mental healthcare, and medical devices (Hayen, 2018[4]).…”

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confidence: 99%

Value-based payment models in primary care: An assessment of the Menzis Shared Savings programme in the Netherlands

2023

OECD Health Working Papers

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2  DELSA/HEA/WD/HWP(2023)10 Unclassified OECD Health Working papers http://www.oecd.org/els/health-systems/health-working-papers.htm OECD Working Papers should not be reported as representing the official views of the OECD or of its member countries. The opinions expressed and arguments employed are those of the author(s).Working Papers describe preliminary results or research in progress by the author(s) and are published to stimulate discussion on a broad range of issues on which the OECD works. Comments on Working Papers are welcomed, and may be sent to

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Towards population-based payment models in a multiple-payer system: the case of the Netherlands

Cited by 7 publications

References 39 publications

Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands

Improving Performance in Complex Surroundings: A Mixed Methods Evaluation of Two Hospital Strategies in the Netherlands

Effects of and Prospects for the Hierarchical Medical Policy in Beijing, China

Value-based payment models in primary care: An assessment of the Menzis Shared Savings programme in the Netherlands

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