Summary
Summary Module 7: Increasing value through payment reform - A health insurer's perspective
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There is an unexplained variation in health care expenditures in the Netherlands. Thisvariation is very costly and poses a big problem to the financial stability of the health care
system.
What can health insurers do about variation in health care:
● The rules of the game:
○ Mandatory coverage
○ Nationally standardized benefit package
○ Community rating
○ Duty of care
○ Risk adjustment
● So, can we perhaps contract selectively to tackle waste?
○ Contracting low-waste providers only
○ Barriers to selective contracting:
■ Difficulties in measuring value in health care
● What is quality in health care?
● Value constitutes different things for different people
● Data quality needs to be similar across providers
■ People highly value freedom of choice
■ Health insurers still need to partly reimburse care delivered by non-
contracted providers
■ People do not trust health insurers
Contracting selectively is difficult, but we can change incentives within contracts.
Changing financial incentives might help reducing waste. Financial incentives →
how care providers are compensated for their work, influences their behavior →
fixed salary, fee-for-service, episode-based payment, capitation, global budget.
Financial incentives → roles → system goals.
The right financial incentives are key to achieving your system goals (Quality, accessibility,
sustainability.) :
● Critical gatekeeper to specialist care.
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