More and more countries rely on risk equalization to compensate competing health insurers for predictable variation in healthcare expenses between healthy individuals and the chronically ill. Recent studies have shown that even the most sophisticated risk equalization models undercompensate for several groups of people in poor health. Inadequate risk equalization is a potential threat to the accessibility of (good-quality) healthcare since insurers may charge high premiums to groups that are undercompensated or – if premium differentiation is not possible/allowed – insurers have incentives for risk selection. Our research focusses on the evaluation and improvement of risk equalization models. With international colleagues we have founded the “Risk Adjustment Network” in order to endorse an international exchange of scientific results in this field and to enhance the usability of these results in the political process.
| Richard van Kleef (contact person) | Tel: 0104088950 | vankleef@eshpm.eur.nl |
| René van Vliet | Tel: 0104088585 | r.vanvliet@eshpm.eur.nl |
| Wynand van de Ven | Tel: 0104088556 | vandeven@eshpm.eur.nl |
| Frank Eijkenaar | Tel: 0104089183 | eijkenaar@eshpm.eur.nl |
| Danielle Cattel | Tel: 0104088882 | cattel@eshpm.eur.nl |
| Erik Schut | Tel: 0104088558 | schut@eshpm.eur.nl |
| Michel Oskam | Tel: 0104088941 | oskam@eshpm.eur.nl |
| Andreea Panturu | n/a | panturu@eshpm.eur.nl |
A key feature of the Dutch healthcare reforms is that competing health insurers are responsible for the purchasing of healthcare services. Insurers will increasingly be enabled to freely negotiate with providers about price, volume, and performance, with the aim of stimulating providers to improve quality and reduce costs. In this regard the department focuses on important questions, including: which incentives and tools do insurers have to actively fulfill their role as prudent purchaser of care on behalf of their enrollees? To what extent are insurers actually taking up this new role? What obstacles can be identified that hamper insurers from fulfilling their purchasing role, and how can these obstacles be effectively removed? In answering these questions, the department takes into account experiences from other countries, including the United States, The United Kingdom, Germany, and Switzerland.
Erik Schut (contact person) | Tel: 0104088558 | schut@eshpm.eur.nl |
| Marco Varkevisser | Tel: 0104089105 | varkevisser@eshpm.eur.nl |
Wynand van de Ven | Tel: 0104088556 | |
| Frank Eijkenaar | Tel: 0104089183 | eijkenaar@eshpm.eur.nl |
Health insurance schemes worldwide include several forms of cost sharing such as deductibles, coinsurance and copayments. On the one hand cost sharing may enhance efficiency by reducing moral hazard. On the other hand, however, it may reduce solidarity since the elderly and chronically ill may incur higher out-of-pocket expenses than the young and healthy. Our research focusses on the design and effects of cost sharing. An important goal is to develop innovative forms of cost sharing that are both more effective in reducing moral hazard and improve solidarity.
Richard van Kleef (contact person) | Tel: 0104088950 | |
René van Vliet | Tel: 0104088585 | |
Wynand van de Ven | Tel: 0104088556 | |
Daniëlle Cattel | Tel: 0104088882 |
In many countries reform of prevailing payment systems for healthcare providers is high on the agenda. Policymakers and purchasers are increasingly looking for ways to create incentives for a more efficient delivery of healthcare services through the use of alternative payment approaches. In this respect the focus is not only on discouraging needless use of (expensive) care, but increasingly also on incentivizing improvements in the quality of care, including health outcomes. The department studies international experiences with innovative payment methods (e.g. pay-for-performance), including effects on quality, accessibility, and costs. In addition, the department focuses on providing insight in crucial conceptual and practical issues in the design and implementation of payment methods. For example, how to take into account systematic differences in providers’ patient populations (casemix)? How can unintended consequences be effectively prevented? And how to adequately measure and reward providers’ performance regarding quality of care and costs?
| Frank Eijkenaar (contact person) | Tel: 0104089183 | eijkenaar@eshpm.eur.nl |
| Erik Schut | Tel: 0104088558 | schut@eshpm.eur.nl |
| Daniëlle Cattel | Tel: 0104088882 | cattel@eshpm.eur.nl |
| Sanne Allers | Tel: 0104081213 | allers@eshpm.eur.nl |
| Celine Hendriks | n/a | hendriks@eshpm.eur.nl |
| Raf van Gestel | Tel: 0104088989 | vangestel@ese.eur.nl |
| Andreea Panturu | n/a | panturu@eshpm.eur.nl |
| Tadjo Gigengack | n/a | gigengack@eshpm.eur.nl |
In many countries healthcare reforms are taking place aiming at improving efficiency and affordability of healthcare. Often these reforms imply (elements of) regulated competition, i.e. competition among health insurers and among care providers regulated by government in order to achieve the public goals (e.g. affordability and efficiency of care). Realizing these public goals implies that certain preconditions must be fulfilled. Our research focuses not only on the Netherlands, but also on e.g. Belgium, China, Germany, Ireland, Israel en Switzerland. International comparisons result in interesting lessons and important new insights.
Wynand van de Ven (contact person) | Tel: 0104088556 | |
Erik Schut | Tel: 0104088558 |
In the Dutch healthcare system, health insurers are expected to act as prudent buyers of curative healthcare for their enrolees. To stimulate the efficiency and customer focus of health insurers, consumers should feel free to switch to another health insurance policy and make a well-considered choice from the available policies.
Our research focuses on the choice behaviour of people in both the health insurance market and health services markets. The key question is to what extent the choices of consumers and patients are optimal and how these could be improved. Important research questions in this regard are: Which subgroups of consumers are switching? What are the determinants that underlie the switching behaviour of (subgroups of) consumers? What influence do health insurers have on the provider choices of their enrolees who need care? Based on what information do patients choose a healthcare provider? What is the willingness of patients to travel for better care and how sensitive are they to differences in quality and price?
Stéphanie van der Geest (contact person) | Tel: 0104089168 | |
| Marco Varkevisser | Tel: 0104089105 | varkevisser@eshpm.eur.nl |
Wynand van de Ven | Tel: 0104088556 | |
Richard van Kleef | Tel: 0104088950 | |
| Erik Schut | Tel: 0104088558 | schut@eshpm.eur.nl |
Market incentives are increasingly used in the organisation of health care in the Netherlands and in many other countries. This means that detailed supply and price regulation by the government is no longer relied on to match the supply and demand of care. Instead, competition plays an increasingly important role. This market mechanism is of course not an end in itself, but a means to achieve better care at the right price. However, this outcome is not self-evident, because the healthcare market is not an ordinary market. To guarantee the public interests of quality, accessibility and affordability, more government regulation is needed in this sector than in most other sectors. Market regulation in healthcare is therefore far from simple. There is a complex and continuous search for the right balance between market forces and government intervention. These are not mutually exclusive, but should go hand in hand. This leads to important research questions. How can market failures in healthcare be prevented? What forms of regulation are necessary for this? And how should the (potential) tension between cooperation and competition be dealt with from the perspective of the antitrust laws?
| Marco Varkevisser (contact person) | Tel: 0104089105 | varkevisser@eshpm.eur.nl |
| Stéphanie van der Geest | Tel: 0104089168 | vandergeest@eshpm.eur.nl |
| Erik Schut | Tel: 0104088558 | schut@eshpm.eur.nl |
| Frédérique Franken | n/a | f.m.e.franken@eshpm.eur.nl |
| Peter Makai | n/a | makai@eshpm.eur.nl |
| Pim den Boon | n/a | denboon@eshpm.eur.nl |
In 2008 Dutch mental healthcare services – both primary and secondary care– were transferred from the Exceptional Medical Expenses Act to the Health Insurance Act (HIA). In the HIA health insurers purchase mental health care on behalf of their enrolees. Health insurers can negotiate with health care providers about prices, volume and quality of care, and are allowed to selectively contract providers. In this research program we evaluate this reform. The main research questions are:
- How do health insurers purchase care?
- How do health care providers determine their volume (number of treatments and treatment duration), prices and quality?
- Do mental health care providers vary in how they treat patients?
- Do mental health care providers react to financial incentives?
- How do out-of-pocket payments and changes in the basic benefit package influence the demand and supply of mental health care?
Rudy Douven (contact person) | Tel: 0104088525/0615589095 |
Worldwide the organization and financing of long-term care (LTC) is facing serious challenges due to an ageing population. Ensuring financial and fiscal sustainability of LTC systems is indicated as the most important policy priority by policy makers within the OECD. A major research question therefore is how to design a sustainable, accessible, efficient and equitable LTC system.
| Erik Schut (contactpersoon) | Tel: 0104088556 | schut@eshpm.eur.nl |
| Rudy Douven | Tel: 0104088525/0615589095 | r.c.m.h.douven@cpb.nl |