Managed competition in the Dutch health system: is there a realistic alternative?

2011 ◽  
Vol 6 (1) ◽  
pp. 135-137 ◽  
Author(s):  
Frederik T. Schut ◽  
Wynand P. M. M. van de Ven
Keyword(s):  
Health System ◽  
Managed Competition ◽  
Dutch Health

The Dutch health system in 2019: Many major reforms, but still work in progress

Health Policy ◽  
2019 ◽  
Vol 123 (3) ◽  
pp. 249-251 ◽  
Author(s):  
Patrick Jeurissen ◽  
Ewout van Ginneken
Keyword(s):  
Health System ◽  
Work In Progress ◽  
Dutch Health

scholarly journals Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands

2019 ◽  
Vol 15 (3) ◽  
pp. 341-354 ◽  
Author(s):  
Rudy Douven ◽  
Monique Burger ◽  
Frederik Schut
Keyword(s):  
Health Care ◽  
Managed Competition ◽  
Policy Options ◽  
Price Variation ◽  
Price Adjustments ◽  
Dutch Health ◽  
Dutch Health Care ◽  
Hospital Payment ◽  
First Time ◽  
Cross Subsidization

AbstractIn the Dutch health care system, health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product are at least 20% higher or lower than the average contract price in the market. For about half of the products, the highest and the lowest contract prices across hospitals differ by a factor of three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross-subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system, (iii) price adjustments related to negotiated lumpsum payments and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.

scholarly journals Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Melanie Bourque ◽  
Jean-Simon Farrah
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Public Management ◽  
Health Care Services ◽  
New Public Management ◽  
Health Care Systems ◽  
Supply And Demand ◽  
Managed Competition ◽  
Care Systems

In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.

Health System Reform in Mexico: A Critical Review

2007 ◽  
Vol 37 (3) ◽  
pp. 515-535 ◽  
Author(s):  
Asa Cristina Laurell
Keyword(s):  
Public Health ◽  
Health Care ◽  
Social Security ◽  
Health System ◽  
Care Delivery ◽  
Public Health Care ◽  
System Reform ◽  
Managed Competition ◽  
Health System Reform ◽  
Social Security Institute

Last year Lancet published a series of articles on Mexico's 2004 health system reform. This article reviews the reform and its presentation in the Lancet series. The author sees the 2004 reform as a continuation of those initiated in 1995 at the largest public social security institute and in 1996 at the Ministry of Health, following the same conceptual design: “managed competition.” The cornerstone of the 2004 reform—the voluntary Popular Health Insurance (PHI)—will not resolve the problems of the public health care system. The author assesses the robustness and validity of the evidence on which the 2004 reform is based, noting some inconsistencies and methodological errors in the data analysis and in the construction of the “effective coverage” index. Finally, some predictions about the future of PHI are outlined, given its intrinsic weaknesses. The next two or three years are critical for the viability of PHI: both families and states will face increasing difficulties in paying the insurance premium; health infrastructure and staff are insufficient to guarantee the health package services; and the private service contracting will further strain state health ministries' ability to strengthen service supply. Moreover, redistribution of federal health expenditure favoring PHI at the cost of the Social Security Institute will further endanger public health care delivery.

scholarly journals Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study (Preprint)

2021 ◽  
Author(s):  
Véronique L L C Bos ◽  
Tessa Jansen ◽  
Niek S Klazinga ◽  
Dionne S Kringos
Keyword(s):  
Socioeconomic Status ◽  
Health System ◽  
General Public ◽  
Target Audience ◽  
Public Understanding ◽  
Fitness For Purpose ◽  
Dutch Health ◽  
The Right ◽  
Over Time ◽  
Epidemiological Information

BACKGROUND Web-based public reporting by means of dashboards has become an essential tool for governments worldwide to monitor COVID-19 information and communicate it to the public. The actionability of such dashboards is determined by their fitness for purpose—meeting a specific information need—and fitness for use—placing the right information into the right hands at the right time and in a manner that can be understood. OBJECTIVE The aim of this study was to identify specific areas where the actionability of the Dutch government’s COVID-19 dashboard could be improved, with the ultimate goal of enhancing public understanding of the pandemic. METHODS The study was conducted from February 2020 to April 2021. A mixed methods approach was carried out, using (1) a descriptive checklist over time to monitor changes made to the dashboard, (2) an actionability scoring of the dashboard to pinpoint areas for improvement, and (3) a reflection meeting with the dashboard development team to contextualize findings and discuss areas for improvement. RESULTS The dashboard predominantly showed epidemiological information on COVID-19. It had been developed and adapted by adding more in-depth indicators, more geographic disaggregation options, and new indicator themes. It also changed in target audience from policy makers to the general public; thus, a homepage was added with the most important information, using news-like items to explain the provided indicators and conducting research to enhance public understanding of the dashboard. However, disaggregation options such as sex, socioeconomic status, and ethnicity and indicators on dual-track health system management and social and economic impact that have proven to give important insights in other countries are missing from the Dutch COVID-19 dashboard, limiting its actionability. CONCLUSIONS The Dutch COVID-19 dashboard developed over time its fitness for purpose and use in terms of providing epidemiological information to the general public as a target audience. However, to strengthen the Dutch health system’s ability to cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, we advise (1) establishing timely indicators relating to health system capacity, (2) including relevant data disaggregation options (eg, sex, socioeconomic status), and (3) enabling interoperability between social, health, and economic data sources.

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

2021 ◽  
Author(s):  
Sander Holterman ◽  
Marike Hettinga ◽  
Erik Buskens ◽  
Maarten Lahr
Keyword(s):  
Health Care ◽  
Health System ◽  
Task Force ◽  
Public Procurement ◽  
Digital Health ◽  
Third Party ◽  
Framework Analysis ◽  
Factors Influencing ◽  
Dutch Health

Background: Digital health is considered a promising solution in keeping health care accessible and affordable. However, implementation is often complex and sustainable funding schemes are lacking. Despite supporting policy, scaling up innovative forms of health care progresses much slower than intended in Dutch national framework agreements. The aim of this study is to identify factors that influence the procurement of digital health particular in district nursing. Methods: A case study approach was used, in which multiple stakeholder perspectives are compared using thematic framework analysis. The case studied was the procurement of digital health in Dutch district nursing. Literature on implementation of digital health, public procurement and payment models was used to build the analytic framework. We analysed fourteen interviews (secondary data), two focus groups organised by the national task force procurement and eight governmental and third-party reports. Results: Five themes emerged from the analysis: 1) rationale 2) provider-payer relationship, 3) resources, 4) evidence, and 5) the payment model. Per theme a number of factors were identified, mostly related to the design and functioning of the Dutch health system and to the implementation process at providers' side. Conclusions: This study identified factors influencing the procurement of digital health in Dutch district nursing. The findings, however, are not unique for digital health, district nursing or the Dutch health system. The results presented will support policy makers, and decision makers to improve procurement of digital health. Investing in better relationships between payer and care provider organisations and professionals is an important next step towards scaling digital health.

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