Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators

• Published in: Health economics 2016-04, Vol.25 (4), p.408-423
• Main Authors: Portrait, France R. M., van der Galiën, Onno, Van den Berg, Bernard
• Format: Article
• Language: English
• Subjects: Aged; Competition; Cost-Benefit Analysis; Costs; Delivery of Health Care - standards; Diabetes; Diabetes Mellitus - economics; Diabetes Mellitus - therapy; diabetes mellitus type 2; Female; Health care expenditures; Health care industry; Health Care Reform; Health Personnel - economics; Health Personnel - standards; Health promotion; health system reform; healthcare providers' performance; Heterogeneity; Humans; Incentives; Insurance, Health; integrated care; Male; Managed competition; Managed Competition - standards; Managed Competition - statistics & numerical data; Middle Aged; multidimensional quality; Netherlands; Quality Indicators, Health Care; Quality of care; Risk reduction
• ISSN: 1057-9230; 1099-1050
• DOI: 10.1002/hec.3158

Background and objectives: The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition. Data and methods: We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost‐consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers. Results and conclusion: There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition. Copyright © 2015 John Wiley & Sons, Ltd.