SUMMARY ARTICLES OF HEALTHCARE
PURCHASING & SUPPLY CHAINS 2021-20221
1
Authored by Judith van Renselaar, Matthias Hoksbergen, Mente Laven, and Yannick Kunnen
,SUMMARY ARTICLES OF HEALTHCARE PURCHASING & SUPPLY CHAINS 2021-2022 1
TABLE OF CONTENTS
ARTICLE 1: FIVE TYPES OF OECD HEALTHCARE ........................................................................................ 2
ARTICLE 2: THE TRIPLE AIM: CARE, HEALTH, AND COSTS ..................................................................... 8
ARTICLE 3: HOW HEALTHCARE SYSTEMS SHAPE A PURCHASER’S STRATEGIES AND ACTIONS
WHEN MANAGING CHRONIC CARE ................................................................................................................ 12
ARTICLE 4: EFFECTS OF PAY FOR PERFORMANCE IN HEALTH CARE ............................................... 16
ARTICLE 5: HOW TO PAY FOR HEALTHCARE ............................................................................................. 19
ARTICLE 6: THEORY AND PRACTICE IN THE DESIGN OF PHYSICIAN PAYMENT INCENTIVES . 22
ARTICLE 7: BARRIERS TO PAYMENT REFORM: EXPERIENCES FROM NINE DUTCH
POPULATION HEALTH MANAGEMENT SITES.............................................................................................. 26
ARTICLE 8: WHAT IS THE RIGHT SUPPLY CHAIN FOR YOUR PRODUCT? ......................................... 31
ARTICLE 9: STRATEGIC PURCHASING IN PRACTICE: COMPARING TEN EUROPEAN
COUNTRIES .............................................................................................................................................................. 35
ARTICLE 10: USING TIME-DRIVEN ACTIVITY-BASED COSTING TO IDENTIFY VALUE
IMPROVEMENT OPPORTUNITIES IN HEALTHCARE.................................................................................. 40
ARTICLE 11: A TRANSACTION COSTS ANALYSIS OF CHANGING CONTRACTUAL RELATIONS
IN THE ENGLISH NHS............................................................................................................................................ 44
ARTICLE 12: INTEGRATED CARE EXPERIENCES AND OUTCOMES IN GERMANY, THE
NETHERLANDS, AND ENGLAND ........................................................................................................................ 48
ARTICLE 13: COOPETITION IN HEALTHCARE: A MULTI-LEVEL ANALYSIS OF ITS INDIVIDUAL
AND ORGANIZATIONAL DETERMINANTS ..................................................................................................... 51
ARTICLE 14: STRUCTURAL INVESTIGATION OF SUPPLY NETWORKS ............................................... 55
ARTICLE 15: ORCHESTRATION VERSUS BOOKKEEPING: HOW STAKEHOLDERS PRESSURES
DRIVE A HEALTHCARE PURCHASER’S INSTITUTIONAL LOGICS ........................................................ 58
ARTICLE 16: WHAT IS VALUE IN HEALTH CARE? ...................................................................................... 62
ARTICLE 17: STANDARDIZING PATIENT OUTCOMES MEASUREMENT. ............................................. 64
OVERVIEW OF ARTICLE IN A SUMMARY TABLE ....................................................................................... 65
,SUMMARY ARTICLES OF HEALTHCARE PURCHASING & SUPPLY CHAINS 2021-2022 2
ARTICLE 1: FIVE TYPES OF OECD HEALTHCARE
BÖHM, SCHMID, GÖTZE, LANDWEHR & ROTHGANG (2008)
Abstract
This article classifies 30 OECD healthcare systems according to a deductively generated typology by
Rothgang and Wendt [1]. This typology distinguishes three core dimensions of the healthcare system:
regulation, financing, and service provision, and three types of actors: state, societal, and private actors. We
argue that there is a hierarchical relationship between the three dimensions, led by regulation, followed by
financing and finally service provision, where the superior dimension restricts the nature of the subordinate
dimensions. This hierarchy rule limits the number of theoretically plausible types to ten. To test our
argument, we classify 30 OECD healthcare systems, mainly using OECD Health Data and WHO country
reports. The classification results in five system types: the National Health Service, the National Health
Insurance, the Social Health Insurance, the Etatist Social Health Insurance, and the Private Health
System. All five types belong to the group of healthcare system types considered theoretically plausible.
Merely Slovenia does not comply with our assumption of a hierarchy among dimensions and typical actors
due to its singular transformation history.
Introduction
Classifications is the processes of sorting, ordering, and comparing involved in classifying social, political,
or economic entities are intrinsically scientific:
By making such classifications, generalizations regarding the members or properties of given categories
are also made possible.
Field’s early functional categorization examines the extent of public control over healthcare resources
(funding, personnel, knowledge and legitimacy) vis-à-vis professional autonomy.
This paper applies the typology of healthcare systems developed by Rothgang et al. (RW typology) which
includes:
- There exist a hierarchy of dimensions (regulation – financing – service provision) and actors (state
– societal - private).
- Each dimension can be dominated by state, societal or private actors, technically yielding 27
distinct combinations.
- Of the 27 types that the RW typology offers, only ten are logically plausible and thus expected
to occur in the real world.
OECD classification of healthcare systems arrives at three types:
1) The extent of coverage, 2) The mode of financing, and 3) Delivery of healthcare.
Table 1.1: First classification of model features.
Model: Features:
NHS Universal coverage with funding coming mainly from contributions and public or private
model delivery
SHI model Combines universal coverage with funding coming mainly from contributions and public or
private delivery
PHI Coverage is based on private insurance only, which is also the major funding source
model
, SUMMARY ARTICLES OF HEALTHCARE PURCHASING & SUPPLY CHAINS 2021-2022 3
The different approaches to classification share many common concepts and highlight the main categories
that must be considered when classifications are made:
The delivery of services and their financing are core dimensions, at particularly with respect to the extent
which the state intervenes in healthcare and with respect to the public/private mix.
Supplemented with questions of professional autonomy, eligibility, coverage or access, and the
administration of financing the latter al refer to aspects of regulation.
A series of detailed comparative case studies concerned with health system types put the main actors of
health systems as well as modes of governance at the center of their analysis.
Three ideal forms of regulation, corresponding to state-based actors, societal actors and market
participants
As Wendt et al. (RW typology) state, healthcare systems are all about the delivery of health services for
which someone has to raise the money. This establish relationships between providers of services, the
beneficiaries, and financing institutions which have to be regulated. Hence, the healthcare system is defined
by three functional processes: service provision, financing and regulation. Societies can choose from a
set of actors and co-ordination mechanisms ranging from hierarchical state intervention with clear
domination-subordination relationship to collective negotiations, where societal actors enter into long-term
agreements, and dispersed exchange processes on markets
Forms of regulation:
Hierarchy, state-led systems, or command-and-control systems frame one class of coordination or
governance. The second refers to networks, collegiality or corporatism as means of regulation through non-
governmental actors. Finally, the market emerges as a typical mode of regulation in these studies.
The regulation dimension can be structured as the relation between financing agencies, providers, and
(potential) beneficiaries: From this set of actors follow six objects of regulation: coverage, the system of
financing, the remuneration of providers, the access of providers to markets, the access of patients to
providers and the benefit package. The classification of healthcare systems proceeds with the financing
dimension: here, general and earmarked tax revenues reflect state financing. Service provision dimension:
the trichotomous concept is more meaningful since private non-profit providers, reflecting a societal
element, are neither similar to for-profit market actors nor part of the state administration:
The role of public, societal and private providers can be measured using a trichotomous service provision
index:
- allocate weights to the main healthcare sectors (inpatient care, outpatient and dental care,
pharmaceuticals). The public/private mix within each of these sectors is measured.
- Public employment: state actors, while non-profit institutions and their employee stand for the
societal realm.
- The sector weights and the information on the status of hospitals and health professionals are then
used to qualify the service provision dimension.
We assume that the three dimensions are not entirely independent from each other, but follow a clear order,
with regulation leading, followed by the financing dimension, and finally service provision.
Methods
Many health systems do not consist of a unitary scheme, but of several segregated part(s). This study
concentrates on the system(s) with the greatest population coverage.
Neglected systems that cover less than ten percent of the population, because, empirically, subsystems
below this threshold are unlikely to exert enough impact on the overall health system to cause
