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Reindersma T, Fabbricotti I, Ahaus K, Bangma C, Sülz S. Inciting maintenance: Tiered institutional work during value-based payment reform in oncology. Soc Sci Med 2024; 347:116798. [PMID: 38537332 DOI: 10.1016/j.socscimed.2024.116798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 04/20/2024]
Abstract
Value-based payment aims to shift the focus from traditional volume-driven arrangements to a system that rewards providers for the quality and value of care delivered. Previous research has shown that it is difficult for providers to change their medical and organizational practices to adopt value-based payment, but the role of actors in these reforms has remained underexposed. This paper unravels the motives of non-clinical and clinical professionals to maintain institutionalized payment practices when faced with value-based payment. To illuminate these motives, a case study was conducted in a Dutch hospital alliance that aimed to implement value-based payment to incentivize the transition to novel interventions in a prostate cancer care pathway. Data collection consisted of observations and interviews with actors on multiple levels in the hospital (sales departments, medical specialist enterprises (MSEs) and physicians). On each actor level, motives for maintaining currently prevailing institutional practices were present. Regulative maintenance motives were more common for sales managers whereas cultural-cognitive and normative motives seemed to play an important role for physicians. An overarching motive was that desired transitions to novel interventions proved possible under the currently prevailing institutional logic, dismissing an urgent need for payment reform. Our analysis further revealed that actors engage in diverse institutional maintenance work, and that some actor groups' institutional work carries more weight than others because of the dependency relationships that exist between hospitals, MSEs and physicians. Physicians depend on MSEs and sales departments, who act as gatekeepers and buffers, to decide whether the value-based payment reform is either adopted or abandoned.
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Affiliation(s)
- Thomas Reindersma
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands.
| | - Isabelle Fabbricotti
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Kees Ahaus
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Chris Bangma
- Erasmus MC Cancer Institute, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Sandra Sülz
- Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
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2
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Trottmann M, Stam P, Visser J, Brammli-Greenberg S. Balancing between competition and regulation in healthcare markets. Health Econ Policy Law 2023:1-10. [PMID: 38124549 DOI: 10.1017/s1744133123000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Systems of managed competition naturally seek the middle ground between competition and regulation. This debate essay makes the case for adjusting the level of regulation according to the characteristics of the submarket in question. We first develop a theoretical framework that can be used to identify the services in which relatively free competition will be beneficial. The framework is grounded in the economic literature and consists of eight criteria. Targeted regulatory tools are then discussed that can be used to structure submarkets in which these criteria are not (fully) met. Applying this framework and targeted interventions, regulators gain the flexibility to react to potential market failures, without foregoing the benefits of managed competition where it works well. This analysis is highly relevant for countries in transition to managed competition. Regulators can identify potential failure in submarkets for medical services, and apply the necessary regulatory tools to prepare for a smooth transition.
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Affiliation(s)
- Maria Trottmann
- Department of Health Services Research, SWICA, 8401 Winterthur, Switzerland
| | - Piet Stam
- School of Business and Economics, Ethics, Governance and Society, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Equalis Strategy & Modeling B.V., Utrecht, The Netherlands
| | - Johan Visser
- Zorginstituut Nederland, 1112 ZA, Diemen, The Netherlands
| | - Shuli Brammli-Greenberg
- Braun School of Public Health Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
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Remers TE, Wackers EM, van Dulmen SA, Jeurissen PP. Towards population-based payment models in a multiple-payer system: the case of the Netherlands. Health Policy 2022; 126:1151-1156. [DOI: 10.1016/j.healthpol.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 05/10/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022]
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4
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IJntema R, Barten DJ, Duits H, Tjemkes B, Veenhof C. 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. BMC Health Serv Res 2022; 22:990. [PMID: 35922844 PMCID: PMC9351119 DOI: 10.1186/s12913-022-08383-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/22/2022] [Indexed: 11/17/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08383-7.
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Affiliation(s)
- Rutger IJntema
- Research Group Financial-Economic Advise on Innovation, HU University of Applied Sciences Utrecht, Heidelberglaan 15, Utrecht, 3584 CS, the Netherlands.
| | - Di-Janne Barten
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain, Centre Rudolf Magnus, Utrecht University, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hans Duits
- Institute Finance and Accounting, HU University of Applied Sciences Utrecht, Utrecht, the Netherlands
| | - Brian Tjemkes
- Department of Management and Organisation Studies, VU University Amsterdam, Amsterdam, the Netherlands
| | - Cindy Veenhof
- Department of Rehabilitation, Physical Therapy Science and Sports, Brain, Centre Rudolf Magnus, Utrecht University, University Medical Centre Utrecht, Utrecht, the Netherlands
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Hennrich P. Implementation of a Managed Care Programme in Germany Using the Example of the Baden-Wuerttemberg Contract on Care in the Field of Cardiology. Int J Integr Care 2022; 22:10. [PMID: 35892077 PMCID: PMC9284992 DOI: 10.5334/ijic.6470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 04/19/2022] [Indexed: 11/20/2022] Open
Abstract
This thesis analysed the implementation of the German medical specialists’ contract in cardiology, a managed care programme within the state of Baden-Wuerttemberg. Research focused on exploring differences between participating and non-participating physicians, their motivation to participate, actual implementation of the programme and its perceived effects. Mixed methods consisting of questionnaires and qualitative telephone interviews with cardiologists and general practitioners showed that participants were older than non-participants, participation was mainly financially driven and implementation was successful regarding medical aspects, but less so regarding patient services and communication between providers. The majority of physicians in the study perceived little to no impact of the programme on quality and efficiency of cardiology care. Still, they saw their expectations fulfilled.
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IJntema R, Barten DJ, Duits H, Tjemkes B, Veenhof C. Building and changing business models: a qualitative study among Dutch physiotherapy primary healthcare organisations. Prim Health Care Res Dev 2022; 23:e19. [PMID: 35314018 DOI: 10.1017/S1463423621000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To gain insights into what business model-building and model-changing aspects make physiotherapy primary healthcare organisations (PTPHOs) attain and sustain superior performance in a changing environment, according to their managers. Background: Since 2006, the transition towards managed competition in the Dutch healthcare market has been intended to improve the performance of primary healthcare organisations like PTPHOs. In such a market, competition on efficiency with reimbursement system has been introduced. Consequently, performance entails achieving and sustaining quality, efficiency, and financial outcomes. Superior performance requires that PTPHOs continuously align their external environment and internal organisation. The business model literature suggests that business model-building and model-changing support this alignment process. Methods: This qualitative study had an explorative design. A pre-defined interview guide based on business model theory was applied. Semi-structured interviews were conducted with physiotherapy primary healthcare organisation managers and transcribed verbally. The transcripts were analysed using directed content analysis. Findings: The study results show, both verbally and graphically, that PTPHOs generate superior performance in a changing environment through business model-building and model-changing. Participating managers (n = 25) confirmed extant findings that business model-building consists of strategy and business model configuration. In addition, business model-building entails establishing interfaces to exploit external environment and internal organisation information. Also, these interfaces are evaluative techniques and tools, action, and process – make sense of knowledge and information. To sustain superior performance, it is essential to change the business model. This can be achieved through three change cycles: business model change, short-term change, and long-term change. Conclusion: Managers of both superior and lower performance organisations independently stress the importance of the same business model-building and model-changing aspects related to attainment and sustainment of superior performance. However, superior performance PTPHOs address building and changing business models in a more diversified and integrated way than their lower performance counterparts.
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Păduraru O, Moroșanu A, Păduraru CȘ, Cărăușu EM. Healthcare Management: A Bibliometric Analysis Based on the Citations of Research Articles Published between 1967 and 2020. Healthcare (Basel) 2022; 10:555. [PMID: 35327034 PMCID: PMC8954756 DOI: 10.3390/healthcare10030555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
The purpose of this study is to analyse the trends manifested in research literature from the field of healthcare management, with emphasis on bibliometric features and different influencing factors. For this, a search was conducted of nine academic databases between January and May 2021. Article features were registered in our database after first applying the validation criteria used for their inclusion. Then, data regarding the publication of the included articles were collected. The analysis focused on trends over time, topic, and journals in which they were published. Moreover, the effect of some factors on the citation of articles was analysed. Our results showed that the 250 analysed articles were published in 139 journals, and many of were by researchers affiliated with universities in the United States. Over time, the publication of analysed articles and their number of citations registered a continuous increase. The most common topics of focus were healthcare management systems and their challenges. In our study, we identified factors that significantly affect citation number, such as number of years since publication, the number of words in the title, and the number of authors of an article. In addition, major gaps were identified, as were new unresolved challenges that can trigger new research ideas.
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8
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Robson SJ, Looi JCL. Managed care: What are the potential implications for obstetric and gynaecological practice in Australia? Aust N Z J Obstet Gynaecol 2021; 61:813-816. [PMID: 34874551 DOI: 10.1111/ajo.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/05/2021] [Accepted: 09/28/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Stephen J Robson
- Department of Obstetrics and Gynaecology, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy Research and Analysis (CAPIPRA), Canberra, Australian Capital Territory, Australia
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9
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Abstract
OBJECTIVE To provide a clinical update on private health insurance in Australia and outline developments in US-style managed care that are likely to affect psychiatric and other specialist healthcare. We explain aspects of the US health system, which has resulted in a powerful and profitable private health insurance sector, and one of the most expensive and inefficient health systems in the world, with limited patient choice in psychiatric treatment. CONCLUSIONS Australian psychiatrists should be aware of changes to private health insurance that emphasise aspects of managed care such as selective contracting, cost-cutting or capitation of services. These approaches may limit access to private hospital care and diminish the autonomy of patients and practitioners in choosing the most appropriate treatment. Australian patients, carers and practitioners need to be informed about the potential impact of private managed care on patient-centred evidence-based treatment.
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Affiliation(s)
- Jeffrey Cl Looi
- Academic Unit of Psychiatry and Addiction Medicine, The Australian National University Medical School, Canberra, ACT, Australia.,Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia & Private Psychiatrist, Canberra, ACT, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,School of Medicine, The University of Queensland, Woolloongabba, Brisbane, QLD, Australia.,Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Department of Psychiatry, Monash University, Clayton, VIC, Australia
| | - William Pring
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,Monash University, and Centre for Mental Health Education and Research at Delmont Private Hospital, Melbourne, VIC, Australia & Private Psychiatrist, Melbourne, VIC, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
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10
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Holst L, Rademakers JJDJM, Brabers AEM, de Jong JD. The Importance of Choosing a Health Insurance Policy and the Ability to Comprehend That Choice for Citizens in the Netherlands. Health Lit Res Pract 2021; 5:e288-e294. [PMID: 34756120 PMCID: PMC8582231 DOI: 10.3928/24748307-20211010-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background: In a health insurance system based on managed competition, such as in the Netherlands, it is important that all citizens can make well-informed decisions on which policy fits their needs and preferences best. However, partly due to the large variety of health insurance policies, there are indications that a significant group of citizens do not make rational decisions when choosing a policy. Objective: This study aimed to provide more insight into (1) how important it is for citizens in the Netherlands to choose a health insurance policy and (2) how easy it is for them to comprehend the information they receive. Methods: Data were collected by sending a survey to members of the Nivel Dutch Health Care Consumer Panel in February 2017. The response rate was 44% (N = 659). Key Results: Our results indicate that citizens in the Netherlands acknowledge the importance of choosing a health insurance policy, but they also point out that it is difficult to comprehend health insurance information. Conclusion: Our findings suggest that a section of the citizens do not have the appropriate skills to decide which insurance policy best fits their needs and preferences. Having better insight into their level of health insurance literacy is an important step in the process of evaluating the extent to which citizens can fulfill their role in the health insurance system. Our results suggest that it is important to better tailor information on health insurances to the specific needs and skills of the individual. By doing this, citizens will be better supported in making well-informed decisions regarding health insurance policies, which should have a positive effect on the functioning of the Dutch health insurance system. [HLRP: Health Literacy Research and Practice. 2021;5(4):e287–e294.] Plain Language Summary: The number of health insurance policy options to choose from is extensive in the Netherlands. This study explored to what extent citizens in the Netherlands find it important to choose a health insurance policy, and to what extent they comprehend the information they receive. The data were collected in 2017 using the Nivel Dutch Health Care Consumer Panel.
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Affiliation(s)
- Laurens Holst
- Address correspondence to Laurens Holst, MSc, the Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, Utrecht, the Netherlands;
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11
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Zheng S, He A, Yu Y, Jiang L, Liang J, Wang P. Research trends and hotspots of health-related quality of life: a bibliometric analysis from 2000 to 2019. Health Qual Life Outcomes 2021; 19:130. [PMID: 33892744 PMCID: PMC8063463 DOI: 10.1186/s12955-021-01767-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 04/09/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The number of research articles on health-related quality of life (HRQoL) has been strikingly increasing. This study aimed to explore the general trends and hotspots of HRQoL. METHODS Based on the Web of Science database, research on HRQoL published between 2000 and 2019 were identified. A bibliometric analysis was performed based on the number of articles, citations, published journals, authors' addresses, and keywords. Descriptive analysis, visualization of geographic distribution and keyword clustering analysis were applied to the collected data. RESULTS The annual number of articles showed growth over the past twenty years, but the annual total citations and annual citations per article were both in decreasing trends. Articles about HRQoL were more likely to be published in journals of multi-subject categories. The HRQoL research was mainly distributed across North America and Europe throughout the twenty years and ushered in a vigorous development worldwide after 2015. Cooperation strength between domestic institutions was much greater than that of international institutions. HRQoL research had six concentrated clusters: HRQoL, Depression, Obesity, Disability, Oncology, Fatigue. CONCLUSION This study provided an overall perspective of global research trends and hotspots in HRQoL, and a potential insight for future research. HRQoL research had experienced significant increasing development during 2000-2019, especially the HRQoL measurement instruments, however, there were significant regional disparities in scientific output in HRQoL.
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Affiliation(s)
- Si Zheng
- School of Health Sciences, Wuhan University, NO. 115 Donghu Road, Wuhan City, 430071, China
| | - Anqi He
- School of Health Sciences, Wuhan University, NO. 115 Donghu Road, Wuhan City, 430071, China
| | - Yan Yu
- School of Health Sciences, Wuhan University, NO. 115 Donghu Road, Wuhan City, 430071, China
| | - Lingling Jiang
- Wuhan Library, Chinese Academy of Science, NO. 25 West of XiaoHonghan, Wuhan City, 430071, China
| | - Jing Liang
- School of Health Sciences, Wuhan University, NO. 115 Donghu Road, Wuhan City, 430071, China
| | - Peigang Wang
- School of Health Sciences, Wuhan University, NO. 115 Donghu Road, Wuhan City, 430071, China.
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12
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Vaidya S. The impact of premium subsidies on health plan choices in Switzerland: Who responds to the incentives set by in-kind as opposed to cash transfers? Health Policy 2021; 125:675-684. [PMID: 33823984 DOI: 10.1016/j.healthpol.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/03/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
Mandatory health insurance in Switzerland operates on a community-based premium scheme. This can lead to a high financial burden on lower income individuals. Until 2014, premium subsidies were paid as cash transfer or in-kind transfer, providing different incentives to individuals for choosing their health plans. Using a difference-in-differences strategy, the impact of in-kind subsidy transfers on deductible choice and the choice of a cost-saving health plan was evaluated to understand effect heterogeneity based on individual background characteristics. The results indicate that eligible individuals from in-kind transfer cantons in general are incentivized to choose a low deductible plan compared to eligible individuals from cash transfer cantons. This effect is found strongest among female, middle-aged and healthy individuals who have most flexibility in adjusting their health plan choices in response to the financial incentives. Additionally, eligible individuals are less likely to choose a cost-saving health plan compared to a cash transfer canton.
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Affiliation(s)
- Shalvaree Vaidya
- University of Lucerne, Frohburgstrasse 3, 6002 Luzern, Switzerland.
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13
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Orzechowski PE. The Case for a Private Healthcare Insurance Monopoly. Appl Health Econ Health Policy 2018; 16:433-443. [PMID: 29626323 DOI: 10.1007/s40258-018-0381-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This article advocates for a regulated private monopoly as an audacious solution to replace Obamacare, help manage Medicare and Medicaid and reform the US healthcare insurance industry. Contemporary economics vilifies monopolies and praises the 'magic wand' of perfect competition without much debate on the merits of these assumptions. The problems with the perfect competition model as applied to healthcare insurance are well established, but exploration of other possible economic models (i.e. monopoly and oligopoly) as a replacement for Obamacare is non-existent. New thinking about the role of monopolies may help achieve public policy goals and make health insurance available to the largest number of people at a reasonable premium while containing medical costs.
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Affiliation(s)
- Paul E Orzechowski
- College of Staten Island, City University of New York (CUNY), Staten Island, NY, USA.
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14
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Abstract
Managed care (MC) plans have been introduced to curb the ever increasing health care costs. Many previous studies on effectiveness lacked a long-term perspective; hence, the sustainability of (possible) savings remains unclear. Moreover, because of their incentives, MC plans are susceptible to under-provision of care. Most of these possibly negative effects can only be observed in the long-term. This paper analyzes the long-term effects of MC plans on cost savings, mortality, and the use of service, using administrative data from a large Swiss health insurer. The identification is based on a propensity-score matching approach, where individuals who enter an MC plan are compared over 10 years to individuals who remain in a standard fee-for-service plan. Cost savings are substantial and sustainable, and the mortality rate is lower in MC plans. Cost savings are driven by fewer consultations and fewer days in hospital care, although the probability of visiting a provider at least once per year is similar or even higher for persons in MC plans. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lukas Kauer
- CSS Institute for Empirical Health Economics, Lucerne, Switzerland
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15
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van Winssen KPM, van Kleef RC, van de Ven WPMM. A voluntary deductible in health insurance: the more years you opt for it, the lower your premium? Eur J Health Econ 2017; 18:209-226. [PMID: 26857921 PMCID: PMC5313571 DOI: 10.1007/s10198-016-0767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 01/19/2016] [Indexed: 06/05/2023]
Abstract
Adverse selection regarding a voluntary deductible (VD) in health insurance implies that insured only opt for a VD if they expect no (or few) healthcare expenses. This paper investigates two potential strategies to reduce adverse selection: (1) differentiating the premium to the duration of the contract for which the VD holds (ex-ante approach) and (2) differentiating the premium to the number of years for which insured have opted for a VD (ex-post approach). It can be hypothesized that premiums will decrease with the duration of the contract or the number of years for which insured have opted for a VD, providing an incentive to insured to opt for a deductible also in (incidental) years they expect relatively high expenses. To test this hypothesis, we examine which premium patterns would occur under these strategies using data on healthcare expenses and risk characteristics of over 750,000 insured from 6 years. Our results show that, under the assumptions made, only without risk equalization the premiums could decrease with the duration of the contract or the number of years for which insured have opted for a VD. With (sophisticated) risk equalization, decreasing premiums seem unfeasible, both under the ex-ante and ex-post approach. Given these findings, we are sceptical about the feasibility of these strategies to counteract adverse selection.
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Affiliation(s)
- K P M van Winssen
- Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands.
| | - R C van Kleef
- Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
| | - W P M M van de Ven
- Institute of Health Policy and Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, 3062 PA, Rotterdam, The Netherlands
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16
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Determann D, Lambooij MS, de Bekker-Grob EW, Hayen AP, Varkevisser M, Schut FT, Wit GAD. What health plans do people prefer? The trade-off between premium and provider choice. Soc Sci Med 2016; 165:10-18. [PMID: 27485728 DOI: 10.1016/j.socscimed.2016.07.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/10/2016] [Accepted: 07/21/2016] [Indexed: 11/26/2022]
Abstract
Within a healthcare system with managed competition, health insurers are expected to act as prudent buyers of care on behalf of their customers. To fulfil this role adequately, understanding consumer preferences for health plan characteristics is of vital importance. Little is known, however, about these preferences and how they vary across consumers. Using a discrete choice experiment (DCE) we quantified trade-offs between basic health plan characteristics and analysed whether there are differences in preferences according to age, health status and income. We selected four health plan characteristics to be included in the DCE: (i) the level of provider choice and associated level of reimbursement, (ii) the primary focus of provider contracting (price, quality, social responsibility), (iii) the level of service benefits, and (iv) the monthly premium. This selection was based on a literature study, expert interviews and focus group discussions. The DCE consisted of 17 choice sets, each comprising two hypothetical health plan alternatives. A representative sample (n = 533) of the Dutch adult population, based on age, gender and educational level, completed the online questionnaire during the annual open enrolment period for 2015. The final model with four latent classes showed that being able to choose a care provider freely was by far the most decisive characteristic for respondents aged over 45, those with chronic conditions, and those with a gross income over €3000/month. Monthly premium was the most important choice determinant for young, healthy, and lower income respondents. We conclude that it would be very unlikely for half of the sample to opt for health plans with restricted provider choice. However, a premium discount up to €15/month by restricted health plans might motivate especially younger, healthier, and less wealthy consumers to choose these plans.
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Affiliation(s)
- Domino Determann
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Mattijs S Lambooij
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Esther W de Bekker-Grob
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arthur P Hayen
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; Tranzo - Scientific Center for Care and Welfare, Tilburg, The Netherlands
| | - Marco Varkevisser
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Frederik T Schut
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - G Ardine de Wit
- Centre for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands; University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands
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Duijmelinck D, van de Ven W. What can Europe learn from the managed care backlash in the United States? Health Policy 2016; 120:509-18. [DOI: 10.1016/j.healthpol.2016.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 03/12/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
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