Do independent treatment centers offer more value than general hospitals? The case of cataract care

Abstract

Objective To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency. Data Sources Anonymous claims data (2013‐2015) were used. We also obtained quality indicators from a semipublic platform. Study Design This study uses a comparative multilevel analysis, controlling for case mix, to evaluate the performance of ITCs and GHs for patients diagnosed with cataract. Data Collection Reimbursement claims were extracted from existing claims databases of the largest Dutch health insurer. Quality indicators were obtained by external agencies through a mixed‐mode survey. Principal Findings There are no stark differences in complexity of cases for cataract care. ITCs seem to perform surgeries more frequently per care pathway, but conduct a lower number of health care activities per surgical claim. Total average costs are lower in ITCs compared with GHs, but when adjusted for case mix, the differences in costs are lower. The findings with the adjusted quality differences suggest that ITCs outperform GHs on patient satisfaction, but patients’ outcomes are similar. Conclusion This finding supports the postulation—based on the focus factory theory—that ITCs can provide more value for cataract care than GHs.

Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries

“…30 This study found that ITCs scored significantly higher on patient satisfaction compared to GHs, but patient reported outcomes were similar. 30 Empirical evidence from England points towards better clinical outcomes after THR and TKR in ITCs compared to NHS providers. However, differences were small and the authors did not fully adjust for case-mix differences.…”

“…The Dutch Health Care Authority (NZa) found approximately 10%-15% lower contracted prices across the board for ITCs compared to GHs, 11 and another, more recent empirical study finds that ITCs offer 8% lower contracted prices than GHs for cataract care. 30 A lower contracted price could indicate that ITCs have less bargaining power vis-à-vis insurers. This reasoning is supported by existing literature, which found lower profit margins for ITCs compared to GHs.…”

“…60,61 However, some studies indicate that these case-mix differences are not that pronounced. 30,62 We could not control for case-mix when assessing CTS and ACL surgeries. Case-mix could potentially drive quality outcomes for CTS treatments.…”

“…We excluded specialty and academic hospitals from all analyses, because they tend to treat a different and more complex patient group compared to ITCs and GHs. 30 In addition, specialty and academic hospitals have teaching obligations that could affect quality and price. This assumption was relaxed in the robustness analyses.…”

“…One of the explanations for this disparity is that academic hospitals treat a different patient-base when performing cataract surgery. 30 This might suggest that the exclusion of ocular comorbidity does not fully correct for case-mix differences between the different types of providers. Furthermore, the significant relationship between the probability of having revisions within one year after THR and type of provider disappears.…”