IDEAS home Printed from
   My bibliography  Save this article

Effective healthcare cost-containment policies: A systematic review


  • Stadhouders, Niek
  • Kruse, Florien
  • Tanke, Marit
  • Koolman, Xander
  • Jeurissen, Patrick


Unsustainable growth in healthcare expenditure demands effective cost-containment policies. We review policy effectiveness using total payer expenditure as primary outcome measure. We included all OECD member states from 1970 onward. After a rigorous quality appraisal, we included 43 original studies and 18 systematic reviews that cover 341 studies. Policies most often evaluated were payment reforms (10 studies), managed care (8 studies) and cost sharing (6 studies). Despite the importance of this topic, for many widely-used policies very limited evidence is available on their effectiveness in containing healthcare costs. We found no evidence for 21 of 41 major groups of cost-containment policies. Furthermore, many evaluations displayed a high risk of bias. Therefore, policies should be more routinely and rigorously evaluated after implementation. The available high-quality evidence suggests that the cost curve may best be bent using a combination of cost sharing, managed care competition, reference pricing, generic substitution and tort reform.

Suggested Citation

  • Stadhouders, Niek & Kruse, Florien & Tanke, Marit & Koolman, Xander & Jeurissen, Patrick, 2019. "Effective healthcare cost-containment policies: A systematic review," Health Policy, Elsevier, vol. 123(1), pages 71-79.
  • Handle: RePEc:eee:hepoli:v:123:y:2019:i:1:p:71-79
    DOI: 10.1016/j.healthpol.2018.10.015

    Download full text from publisher

    File URL:
    Download Restriction: Full text for ScienceDirect subscribers only

    File URL:
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    1. Martin Gaynor & Rodrigo Moreno-Serra & Carol Propper, 2013. "Death by Market Power: Reform, Competition, and Patient Outcomes in the National Health Service," American Economic Journal: Economic Policy, American Economic Association, vol. 5(4), pages 134-166, November.
    2. H. Gothe & I. Schall & K. Saverno & M. Mitrovic & A. Luzak & D. Brixner & U. Siebert, 2015. "The Impact of Generic Substitution on Health and Economic Outcomes: A Systematic Review," Applied Health Economics and Health Policy, Springer, vol. 13(1), pages 21-33, August.
    3. Kaiser, Ulrich & Mendez, Susan J. & Rønde, Thomas & Ullrich, Hannes, 2014. "Regulation of pharmaceutical prices: Evidence from a reference price reform in Denmark," Journal of Health Economics, Elsevier, vol. 36(C), pages 174-187.
    4. Yip, Winnie C., 1998. "Physician response to Medicare fee reductions: changes in the volume of coronary artery bypass graft (CABG) surgeries in the Medicare and private sectors," Journal of Health Economics, Elsevier, vol. 17(6), pages 675-699, December.
    5. Manning, Willard G, et al, 1987. "Health Insurance and the Demand for Medical Care: Evidence from a Randomized Experiment," American Economic Review, American Economic Association, vol. 77(3), pages 251-277, June.
    6. Hellinger, F.J. & Encinosa, W.E., 2006. "The impact of state laws limiting malpractice damage awards on health care expenditures," American Journal of Public Health, American Public Health Association, vol. 96(8), pages 1375-1381.
    7. Reeves, Aaron & McKee, Martin & Basu, Sanjay & Stuckler, David, 2014. "The political economy of austerity and healthcare: Cross-national analysis of expenditure changes in 27 European nations 1995–2011," Health Policy, Elsevier, vol. 115(1), pages 1-8.
    8. Trabandt, Mathias & Uhlig, Harald, 2011. "The Laffer curve revisited," Journal of Monetary Economics, Elsevier, vol. 58(4), pages 305-327.
    9. Ming Tai‐Seale & Thomas H. Rice & Sally C. Stearns, 1998. "Volume responses to medicare payment reductions with multiple payers: a test of the McGuire–Pauly model," Health Economics, John Wiley & Sons, Ltd., vol. 7(3), pages 199-219, May.
    10. Han, Euna & Chae, Su-Mi & Kim, Nam-Soon & Park, Sylvia, 2015. "Effects of pharmaceutical cost containment policies on doctors’ prescribing behavior: Focus on antibiotics," Health Policy, Elsevier, vol. 119(9), pages 1245-1254.
    11. Chernew, Michael & DeCicca, Philip & Town, Robert, 2008. "Managed care and medical expenditures of Medicare beneficiaries," Journal of Health Economics, Elsevier, vol. 27(6), pages 1451-1461, December.
    12. Christoph Schwierz, 2016. "Cost-Containment Policies in Hospital Expenditure in the European Union," European Economy - Discussion Papers 2015 - 037, Directorate General Economic and Financial Affairs (DG ECFIN), European Commission.
    13. Vogler, Sabine & Zimmermann, Nina & de Joncheere, Kees, 2016. "Policy interventions related to medicines: Survey of measures taken in European countries during 2010–2015," Health Policy, Elsevier, vol. 120(12), pages 1363-1377.
    14. Ilaria Mosca, 2007. "Decentralization as a determinant of health care expenditure: empirical analysis for OECD countries," Applied Economics Letters, Taylor & Francis Journals, vol. 14(7), pages 511-515.
    15. Gusmano, Michael K. & Allin, Sara, 2014. "Framing the issue of ageing and health care spending in Canada, the United Kingdom and the United States," Health Economics, Policy and Law, Cambridge University Press, vol. 9(3), pages 313-328, July.
    16. Joan Costa-Font & Francesco Moscone, 2009. "The impact of decentralization and inter-territorial interactions on Spanish health expenditure," Studies in Empirical Economics, in: Giuseppe Arbia & Badi H. Baltagi (ed.), Spatial Econometrics, pages 167-184, Springer.
    17. Randall P. Ellis & Thomas G. McGuire, 1993. "Supply-Side and Demand-Side Cost Sharing in Health Care," Journal of Economic Perspectives, American Economic Association, vol. 7(4), pages 135-151, Fall.
    18. Glasgow, R.E. & Vogt, T.M. & Boles, S.M., 1999. "Evaluating the public health impact of health promotion interventions: The RE-AIM framework," American Journal of Public Health, American Public Health Association, vol. 89(9), pages 1322-1327.
    19. Rodrigo Moreno-Serra, 2014. "The impact of cost-containment policies on health expenditure: Evidence from recent OECD experiences," OECD Journal on Budgeting, OECD Publishing, vol. 13(3), pages 1-29.
    20. Melnick, G.A. & Zwanziger, J., 1995. "State health care expenditures under competition and regulation, 1980 through 1991," American Journal of Public Health, American Public Health Association, vol. 85(10), pages 1391-1396.
    21. Huckfeldt, Peter J. & Sood, Neeraj & Escarce, José J. & Grabowski, David C. & Newhouse, Joseph P., 2014. "Effects of Medicare payment reform: Evidence from the home health interim and prospective payment systems," Journal of Health Economics, Elsevier, vol. 34(C), pages 1-18.
    22. Park, Chan-Mi & Lee, Kun-Sei & Han, Euna & Kim, Dong-Sook, 2016. "Effects of delisting nonprescription combination drugs on health insurance expenditures for pharmaceuticals in Korea," Health Policy, Elsevier, vol. 120(6), pages 590-595.
    23. János Kornai, 2009. "The soft budget constraint syndrome in the hospital sector," Society and Economy, Akadémiai Kiadó, Hungary, vol. 31(1), pages 5-31, June.
    24. Christine de la Maisonneuve & Joaquim Oliveira Martins, 2013. "Public Spending on Health and Long-term Care: A new set of projections," OECD Economic Policy Papers 6, OECD Publishing.
    25. Craig, Steven G. & Howard, Larry L., 2014. "Is Medicaid crowding out other state government expenditure? Internal financing and cross-program substitution," Regional Science and Urban Economics, Elsevier, vol. 49(C), pages 164-178.
    26. Martin, Stephen, 2010. "Industrial Organization in Context," OUP Catalogue, Oxford University Press, number 9780199291199.
    27. Allen, Pauline, 2006. "New localism in the English National Health Service: What is it for?," Health Policy, Elsevier, vol. 79(2-3), pages 244-252, December.
    28. Murthy, Vasudeva N.R. & Okunade, Albert A., 2016. "Determinants of U.S. health expenditure: Evidence from autoregressive distributed lag (ARDL) approach to cointegration," Economic Modelling, Elsevier, vol. 59(C), pages 67-73.
    29. Abel-Smith, Brian & Mossialos, Elias, 1994. "Cost containment and health care reform: a study of the European Union," Health Policy, Elsevier, vol. 28(2), pages 89-132, May.
    30. Nguyen, Xuan Nguyen, 1996. "Physician volume response to price controls," Health Policy, Elsevier, vol. 35(2), pages 189-204, February.
    31. Kim, Jiyun & Ko, Sukyoung & Yang, Bongmin, 2005. "The effects of patient cost sharing on ambulatory utilization in South Korea," Health Policy, Elsevier, vol. 72(3), pages 293-300, June.
    32. M. Kate Bundorf, 2016. "Consumer-Directed Health Plans: A Review Of The Evidence," Journal of Risk & Insurance, The American Risk and Insurance Association, vol. 83(1), pages 9-41, January.
    33. Dixon, Anna & Poteliakhoff, Emmi, 2012. "Back to the future: 10 years of European health reforms," Health Economics, Policy and Law, Cambridge University Press, vol. 7(01), pages 1-10, January.
    34. Evans, R.G. & Lomas, J. & Barer, M.A. & Labelle, R.J. & Fooks, C. & Stoddart, G.L. & Anderson, G.M. & Feeny, D. & Gafni, A. & Torrance, G.W. & Tholl, W.G., 1989. "Controlling Health Expenditures- The Canadian Reality," Centre for Health Services and Policy Research 89:11r, University of British Columbia - Centre for Health Services and Policy Research..
    35. Andree Ehlert & Dirk Oberschachtsiek, 2014. "Does managed care reduce health care expenditure? Evidence from spatial panel data," International Journal of Health Economics and Management, Springer, vol. 14(3), pages 207-227, September.
    36. Martin Emmert & Frank Eijkenaar & Heike Kemter & Adelheid Esslinger & Oliver Schöffski, 2012. "Economic evaluation of pay-for-performance in health care: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(6), pages 755-767, December.
    37. Anil Bamezai & Jack Zwanziger & Glenn A. Melnick & Joyce M. Mann, 1999. "Price competition and hospital cost growth in the United States (1989–1994)," Health Economics, John Wiley & Sons, Ltd., vol. 8(3), pages 233-243, May.
    38. Kranker, Keith, 2016. "Effects of Medicaid disease management programs on medical expenditures: Evidence from a natural experiment in Georgia," Journal of Health Economics, Elsevier, vol. 46(C), pages 52-69.
    39. Jonathan A. Rodden & Gunnar S. Eskeland (ed.), 2003. "Fiscal Decentralization and the Challenge of Hard Budget Constraints," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262182297.
    40. Medin, Emma & Häkkinen, Unto & Linna, Miika & Anthun, Kjartan S. & Kittelsen, Sverre A.C. & Rehnberg, Clas, 2013. "International hospital productivity comparison: Experiences from the Nordic countries," Health Policy, Elsevier, vol. 112(1), pages 80-87.
    41. Ronen Avraham & Leemore S. Dafny & Max M. Schanzenbach, 2012. "The Impact of Tort Reform on Employer-Sponsored Health Insurance Premiums," Journal of Law, Economics, and Organization, Oxford University Press, vol. 28(4), pages 657-686, October.
    42. Stadhouders, Niek & Koolman, Xander & Tanke, Marit & Maarse, Hans & Jeurissen, Patrick, 2016. "Policy options to contain healthcare costs: a review and classification," Health Policy, Elsevier, vol. 120(5), pages 486-494.
    43. Livio Garattini & Simone Ghislandi, 2006. "Off-patent drugs in Italy," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 7(1), pages 79-83, March.
    Full references (including those not matched with items on IDEAS)


    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.

    Cited by:

    1. Braendle, Thomas & Colombier, Carsten, 2020. "Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad," Health Policy, Elsevier, vol. 124(6), pages 605-614.
    2. Cicellin, Mariavittoria & Adriana Scuotto, & Canonico, Paolo & Consiglio, Stefano & Mercurio, Lorenzo, 2019. "Understanding the low cost business model in healthcare service provision: A comparative case study in Italy," Social Science & Medicine, Elsevier, vol. 240(C).
    3. Brigitte Woo & Karen Koh & Wentao Zhou & Toon Wei Lim & Violeta Lopez & Wilson Tam, 2020. "Understanding the role of an advanced practice nurse through the perspectives of patients with cardiovascular disease: A qualitative study," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(9-10), pages 1623-1634, May.
    4. van Dijk, T.S. (Tessa) & van der Scheer, W.K. (Wilma) & Janssen, R.T.J.M. (Richard), 2021. "Power, legitimacy and urgency: Unravelling the relationship between Dutch healthcare organisations and their financial stakeholders," Health Policy, Elsevier, vol. 125(8), pages 1077-1084.
    5. Polin, Katherine & Hjortland, Maximilien & Maresso, Anna & van Ginneken, Ewout & Busse, Reinhard & Quentin, Wilm, 2021. "“Top-Three” health reforms in 31 high-income countries in 2018 and 2019: an expert informed overview," Health Policy, Elsevier, vol. 125(7), pages 815-832.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Michael Batty & Benedic Ippolito, 2017. "Financial Incentives, Hospital Care, and Health Outcomes: Evidence from Fair Pricing Laws," American Economic Journal: Economic Policy, American Economic Association, vol. 9(2), pages 28-56, May.
    2. Benedic N. Ippolito, 2016. "Financial incentives, hospital care, and health outcomes: Evidence from fair pricing laws," AEI Economics Working Papers 863745, American Enterprise Institute.
    3. Trottmann, Maria & Zweifel, Peter & Beck, Konstantin, 2012. "Supply-side and demand-side cost sharing in deregulated social health insurance: Which is more effective?," Journal of Health Economics, Elsevier, vol. 31(1), pages 231-242.
    4. Schmitz, Hendrik, 2013. "Practice budgets and the patient mix of physicians – The effect of a remuneration system reform on health care utilisation," Journal of Health Economics, Elsevier, vol. 32(6), pages 1240-1249.
    5. Braendle, Thomas & Colombier, Carsten, 2020. "Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad," Health Policy, Elsevier, vol. 124(6), pages 605-614.
    6. Pessino, Carola & Izquierdo, Alejandro & Vuletin, Guillermo, 2018. "Better Spending for Better Lives: How Latin America and the Caribbean Can Do More with Less," IDB Publications (Books), Inter-American Development Bank, number 9152, October.
    7. Abe Dunn & Adam Hale Shapiro, 2018. "Physician Competition and the Provision of Care: Evidence from Heart Attacks," American Journal of Health Economics, University of Chicago Press, vol. 4(2), pages 226-261, Spring.
    8. Martin Gaynor & Kate Ho & Robert J. Town, 2015. "The Industrial Organization of Health-Care Markets," Journal of Economic Literature, American Economic Association, vol. 53(2), pages 235-284, June.
    9. Daniel Burkhard & Christian P. R. Schmid & Kaspar Wüthrich, 2019. "Financial incentives and physician prescription behavior: Evidence from dispensing regulations," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1114-1129, September.
    10. Ching‐To Albert Ma & Thomas G. Mcguire, 2002. "Network Incentives in Managed Health Care," Journal of Economics & Management Strategy, Wiley Blackwell, vol. 11(1), pages 1-35, March.
    11. Buczak-Stec, Elżbieta & Goryński, Paweł & Nitsch-Osuch, Aneta & Kanecki, Krzysztof & Tyszko, Piotr, 2017. "The impact of introducing a new hospital financing system (DRGs) in Poland on hospitalisations for atherosclerosis: An interrupted time series analysis (2004–2012)," Health Policy, Elsevier, vol. 121(11), pages 1186-1193.
    12. Toon van der Gronde & Carin A Uyl-de Groot & Toine Pieters, 2017. "Addressing the challenge of high-priced prescription drugs in the era of precision medicine: A systematic review of drug life cycles, therapeutic drug markets and regulatory frameworks," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-34, August.
    13. Jana Votapkova & Pavlina Zilova, 2016. "The abolition of user charges and the demand for ambulatory visits: evidence from the Czech Republic," Health Economics Review, Springer, vol. 6(1), pages 1-11, December.
    14. Boone, Jan, 2019. "Health provider networks with private contracts: Is there under-treatment in narrow networks?," Journal of Health Economics, Elsevier, vol. 67(C).
    15. Claudia Keser & Claude Montmarquette & Martin Schmidt & Cornelius Schnitzler, 2020. "Custom-made health-care: an experimental investigation," Health Economics Review, Springer, vol. 10(1), pages 1-12, December.
    16. Landsem, Mari Magnussen & Magnussen, Jon, 2018. "The effect of copayments on the utilization of the GP service in Norway," Social Science & Medicine, Elsevier, vol. 205(C), pages 99-106.
    17. Herr, A. & Suppliet, M., 2011. "Co-Payment Exemptions and Reference Prices: an Empirical Study of Pharmaceutical Prices in Germany," Health, Econometrics and Data Group (HEDG) Working Papers 11/18, HEDG, c/o Department of Economics, University of York.
    18. Jerome Dugan, 2015. "Trends in Managed Care Cost Containment: An Analysis of the Managed Care Backlash," Health Economics, John Wiley & Sons, Ltd., vol. 24(12), pages 1604-1618, December.
    19. Elizabeth L. Munnich & Michael R. Richards, 2020. "Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1343-1363, November.


    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:hepoli:v:123:y:2019:i:1:p:71-79. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: . General contact details of provider: .

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu or (email available below). General contact details of provider: .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service hosted by the Research Division of the Federal Reserve Bank of St. Louis . RePEc uses bibliographic data supplied by the respective publishers.