The Effect of Competition on Process and Outcome Quality of Hospital Care in the Netherlands

Bijlsma, Michiel; Koning, Pierre; Shestalova, Victoria

doi:10.1007/s10645-013-9203-7

Cited by 16 publications

(17 citation statements)

References 28 publications

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“…In the Netherlands, two papers have examined the competition-quality relationship [ 2 , 15 ]. Bijlsma et al [ 2 ] used outcome and process-quality indicators after managed competition was introduced in Dutch hospitals. They used the Basic Data Set of the Health Inspectorate from the period 2004–2008.…”

Section: Literaturementioning

confidence: 99%

“…Even when quality information is noisy (for example because quality data is not adjusted for case mix), this relationship holds. Beukers et al [ 2 ] studied this relationship with regard to hip replacements in the period 2008–2010. Their logit regressions indicate that although the relationship between quality and patient hospital choice is significant, travel time is a more important indicator of patients choice of hospital.…”

Section: Literaturementioning

confidence: 99%

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Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

2017

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There is much debate about the effect of competition in healthcare and especially the effect of competition on the quality of healthcare, although empirical evidence on this subject is mixed. The Netherlands provides an interesting case in this debate. The Dutch system could be characterized as a system involving managed competition and mandatory healthcare insurance. Information about the quality of care provided by hospitals has been publicly available since 2008. In this paper, we evaluate the relationship between quality scores for three diagnosis groups and the market power indicators of hospitals. We estimate the impact of competition on quality in an environment of liberalized pricing. For this research, we used unique price and production data relating to three diagnosis groups (cataract, adenoid and tonsils, bladder tumor) produced by Dutch hospitals in the period 2008–2011. We also used the quality indicators relating to these diagnosis groups. We reveal a negative relationship between market share and quality score for two of the three diagnosis groups studied, meaning that hospitals in competitive markets have better quality scores than those in concentrated markets. We therefore conclude that more competition is associated with higher quality scores.

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Section: Literaturementioning

confidence: 99%

Section: Literaturementioning

confidence: 99%

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

2017

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“…The Netherlands has the second highest number of websites (eleven) of any country offering information on health care quality [ 67 ], hospitals have been compelled to report standardized quality indicators since 2009 [ 68 ], and consumer surveys routinely assess satisfaction with insurers and providers [ 14 ]. Average performance on the majority of hospital process and outcome indicators improved over 2004 - 2008, although some clinical metrics deteriorated [ 68 ].…”

Section: Transparency and Consumer Informationmentioning

confidence: 99%

“Managed competition” for Ireland? The single versus multiple payer debate

Mikkers

Ryan

2014

BMC Health Serv Res

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BackgroundA persistent feature of international health policy debate is whether a single-payer or multiple-payer system can offer superior performance. In Ireland, a major reform proposal is the introduction of ‘managed competition’ based on the recent reforms in the Netherlands, which would replace many functions of Ireland’s public payer with a system of competing health insurers from 2016. This article debates whether Ireland meets the preconditions for effective managed competition, and whether the government should implement the reform according to its stated timeline. We support our arguments by discussing the functioning of the Dutch and Irish systems.DiscussionAlthough Ireland currently lacks key preconditions for effective implementation, the Dutch experience demonstrates that some of these can be implemented over time, such as a more rigorous risk equalization system. A fundamental problem may be Ireland’s sparse hospital distribution. This may increase the market power of hospitals and weaken insurers’ ability to exclude inefficient or poor quality hospitals from contracts, leading to unwarranted spending growth. To mitigate this, the government proposes to introduce a system of price caps for hospital services.The Dutch system of competition is still in transition and it is premature to judge its success. The new system may have catalyzed increased transparency regarding clinical performance, but outcome measurement remains crude. A multi-payer environment creates some disincentives for quality improvement, one of which is free-riding by insurers on their rivals’ quality investments. If a Dutch insurer invests in improving hospital quality, hospitals will probably offer equivalent quality to consumers enrolled with other insurance companies. This enhances equity, but may weaken incentives for improvement. Consequently the Irish government, rather than insurers, may need to assume responsibility for investing in clinical quality. Plans are in place to assure consumers of free choice of insurer, but a key concern is a potential shortfall of institutional capacity to regulate managed competition.SummaryManaged competition requires a long transition period and the requisite preconditions are not yet in place. The Irish government should refrain from introducing managed competition until sufficient preconditions are in place to allow effective performance.

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“…NHS hospitals in more competitive regions provide higher health care quality compared to hospitals located in regions where there is less competition [ 61 ]. In the same line, Bijlsma et al [ 4 ] study the impact of competition introduced in The Netherlands from 2004 to 2008 on a wide range of quality measures. The results indicate that hospitals in areas with stronger competition show higher improvement in several process measures of quality but the impact of competition on outcome measures appears negligible.…”

Section: Introductionmentioning

confidence: 99%

Hospital heterogeneity: what drives the quality of health care

2017

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A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals’ human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

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The Effect of Competition on Process and Outcome Quality of Hospital Care in the Netherlands

Cited by 16 publications

References 28 publications

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

Competition and quality indicators in the health care sector: empirical evidence from the Dutch hospital sector

“Managed competition” for Ireland? The single versus multiple payer debate

Hospital heterogeneity: what drives the quality of health care

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