Financial risk allocation and provider incentives in hospital-insurer contracts in The Netherlands.

Autor: Gajadien CS; Dutch Healthcare Authority (Nederlandse Zorgautoriteit; NZa), Utrecht, The Netherlands. cgajadien@nza.nl.; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. cgajadien@nza.nl., Dohmen PJG; Dutch Healthcare Authority (Nederlandse Zorgautoriteit; NZa), Utrecht, The Netherlands.; Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Eijkenaar F; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Schut FT; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., van Raaij EM; Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands., Heijink R; The Council of Public Health & Society (Raad voor Volksgezondheid & Samenleving; RVS), The Hague, The Netherlands.
Jazyk: angličtina
Zdroj: The European journal of health economics : HEPAC : health economics in prevention and care [Eur J Health Econ] 2023 Feb; Vol. 24 (1), pp. 125-138. Date of Electronic Publication: 2022 Apr 12.
DOI: 10.1007/s10198-022-01459-5
Abstrakt: In healthcare systems with a purchaser-provider split, contracts are an important tool to define the conditions for the provision of healthcare services. Financial risk allocation can be used in contracts as a mechanism to influence provider behavior and stimulate providers to provide efficient and high-quality care. In this paper, we provide new insights into financial risk allocation between insurers and hospitals in a changing contracting environment. We used unique nationwide data from 901 hospital-insurer contracts in The Netherlands over the years 2013, 2016, and 2018. Based on descriptive and regression analyses, we find that hospitals were exposed to more financial risk over time, although this increase was somewhat counteracted by an increasing use of risk-mitigating measures between 2016 and 2018. It is likely that this trend was heavily influenced by national cost control agreements. In addition, alternative payment models to incentivize value-based health care were rarely used and thus seemingly of lower priority, despite national policies being explicitly directed at this goal. Finally, our analysis shows that hospital and insurer market power were both negatively associated with financial risk for hospitals. This effect becomes stronger if both hospital and insurer have strong market power, which in this case may indicate a greater need to reduce (financial) uncertainties and to create more cooperative relationships.
(© 2022. The Author(s).)
Databáze: MEDLINE
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