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Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients

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  • Karimi, Milad
  • Tsiachristas, Apostolos
  • Looman, Willemijn
  • Stokes, Jonathan
  • Galen, Mirte van
  • Rutten-van Mölken, Maureen

Abstract

Bundled payments aim to stimulate the integration of healthcare services and ultimately reduce healthcare expenditure growth through improved quality of care. The Netherlands introduced bundled payments for chronic diseases in 2010 by reimbursing providers annually for a bundle of primary care services related to COPD, Diabetes, or Vascular Risk Management. We aimed to assess the long-term effects of these bundled payments on healthcare expenditure. We used health insurance claims data from 2008 to 2015 to compare the healthcare expenditure between everyone who was included in bundled payments and a control group. We performed a difference-in-difference analysis in combination with propensity score matching and found that bundled payments consistently increased health care expenditure over seven years. The average half-year increase was €233 (95%CI: 204-262) for DM2, €609 (95%CI: 533-686) for COPD, and €231 (95%CI: 208-254) for VRM, representing 13%, 52%, and 20% of 2008 half-year cost. The increase was higher for those with multimorbidity compared to those without multimorbidity. This suggests that the expectations of the bundled payments are yet to be fulfilled.

Suggested Citation

  • Karimi, Milad & Tsiachristas, Apostolos & Looman, Willemijn & Stokes, Jonathan & Galen, Mirte van & Rutten-van Mölken, Maureen, 2021. "Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients," Health Policy, Elsevier, vol. 125(6), pages 751-759.
    • Handle: RePEc:eee:hepoli:v:125:y:2021:i:6:p:751-759
    DOI: 10.1016/j.healthpol.2021.04.004
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    References listed on IDEAS

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    1. Stokes, Jonathan & Struckmann, Verena & Kristensen, Søren Rud & Fuchs, Sabine & van Ginneken, Ewout & Tsiachristas, Apostolos & Rutten van Mölken, Maureen & Sutton, Matt, 2018. "Towards incentivising integration: A typology of payments for integrated care," Health Policy, Elsevier, vol. 122(9), pages 963-969.
    2. van der Heide, Iris & Snoeijs, Sanne & Quattrini, Sabrina & Struckmann, Verena & Hujala, Anneli & Schellevis, François & Rijken, Mieke, 2018. "Patient-centeredness of integrated care programs for people with multimorbidity. Results from the European ICARE4EU project," Health Policy, Elsevier, vol. 122(1), pages 36-43.
    3. de Vries, Eline F. & Drewes, Hanneke W. & Struijs, Jeroen N. & Heijink, Richard & Baan, Caroline A., 2019. "Barriers to payment reform: Experiences from nine Dutch population health management sites," Health Policy, Elsevier, vol. 123(11), pages 1100-1107.
    4. Tsiachristas, Apostolos & Hipple-Walters, Bethany & Lemmens, Karin M.M. & Nieboer, Anna P. & Rutten-van Mölken, Maureen P.M.H., 2011. "Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers," Health Policy, Elsevier, vol. 101(2), pages 122-132, July.
    5. Tsiachristas, Apostolos & Dikkers, Carolien & Boland, Melinde R.S. & Rutten-van Mölken, Maureen P.M.H., 2013. "Exploring payment schemes used to promote integrated chronic care in Europe," Health Policy, Elsevier, vol. 113(3), pages 296-304.
    6. Marco Caliendo & Sabine Kopeinig, 2008. "Some Practical Guidance For The Implementation Of Propensity Score Matching," Journal of Economic Surveys, Wiley Blackwell, vol. 22(1), pages 31-72, February.
    7. Yi Hsuan Chen & Milad Karimi & Maureen P M H Rutten-van Mölken, 2020. "The disease burden of multimorbidity and its interaction with educational level," PLOS ONE, Public Library of Science, vol. 15(12), pages 1-18, December.
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    1. Thomas Reindersma & Isabelle Fabbricotti & Kees Ahaus & Sandra Sülz, 2022. "Integrated Payment, Fragmented Realities? A Discourse Analysis of Integrated Payment in the Netherlands," IJERPH, MDPI, vol. 19(14), pages 1-14, July.
    2. Christian Volmar Skovsgaard & Troels Kristensen & Ryan Pulleyblank & Kim Rose Olsen, 2023. "Increasing capitation in mixed remuneration schemes: Effects on service provision and process quality of care," Health Economics, John Wiley & Sons, Ltd., vol. 32(11), pages 2477-2498, November.
    3. Sterre S. Bour & Lena H. A. Raaijmakers & Erik W. M. A. Bischoff & Lucas M. A. Goossens & Maureen P. M. H. Rutten-van Mölken, 2023. "How Can a Bundled Payment Model Incentivize the Transition from Single-Disease Management to Person-Centred and Integrated Care for Chronic Diseases in the Netherlands?," IJERPH, MDPI, vol. 20(5), pages 1-20, February.
    4. Yordanov, Dimitar & Oxholm, Anne Sophie & Prætorius, Thim & Kristensen, Søren Rud, 2024. "Financial incentives for integrated care: A scoping review and lessons for evidence-based design," Health Policy, Elsevier, vol. 141(C).
    5. Sterre S. Bour & Lucas M. A. Goossens & Maureen P. M. H. Rutten-van Mölken, 2025. "Characterizing a heterogeneous chronic patient population for redesigning person-centred bundled payment models using risk-mitigating measures," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 26(7), pages 1249-1262, September.

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