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Does managed competition constrain hospitals’ contract prices? Evidence from the Netherlands

Author

Listed:
  • Rudy Douven

    (CPB Netherlands Bureau for Economic Policy Analysis)

  • Monique Burger
  • Erik Schut

Abstract

In the Dutch health care system health insurers negotiate with hospitals about the pricing of hospital products in a managed competition framework. In this paper, we study these contract prices that became for the first time publicly available in 2016. The data show substantive price variation between hospitals for the same products, and within a hospital for the same product across insurers. About 27% of the contract prices for a hospital product is 20% higher or lower than the average contract price in the market. For about half of the products the highest and lowest contract price across hospitals differ by a factor three or more. Moreover, hospital product prices do not follow a consistent ranking across hospitals, suggesting substantial cross subsidization between hospital products. Potential explanations for the large and seemingly random price variation are: (i) different cost pricing methods used by hospitals, (ii) uncertainty due to frequent changes in the hospital payment system; (iii) price adjustments related to negotiated lumpsum payments, and (iv) differences in hospital and insurer market power. Several policy options are discussed to reduce variation and increase transparency of hospital prices.

Suggested Citation

  • Rudy Douven & Monique Burger & Erik Schut, 2018. "Does managed competition constrain hospitals’ contract prices? Evidence from the Netherlands," CPB Discussion Paper 378, CPB Netherlands Bureau for Economic Policy Analysis.
    • Handle: RePEc:cpb:discus:378
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    References listed on IDEAS

    as
    1. Schut, Frederik T. & van de Ven, Wynand P. M. M., 2011. "Effects of purchaser competition in the Dutch health system: is the glass half full or half empty?," Health Economics, Policy and Law, Cambridge University Press, vol. 6(1), pages 109-123, January.
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    3. Moriya, Asako S. & Vogt, William B. & Gaynor, Martin, 2010. "Hospital prices and market structure in the hospital and insurance industries," Health Economics, Policy and Law, Cambridge University Press, vol. 5(4), pages 459-479, October.
    4. Katherine Ho, 2009. "Insurer-Provider Networks in the Medical Care Market," American Economic Review, American Economic Association, vol. 99(1), pages 393-430, March.
    5. Wynand P. M. M. Van de Ven & Frederik T. Schut, 2009. "Managed competition in the Netherlands: still work‐in‐progress," Health Economics, John Wiley & Sons, Ltd., vol. 18(3), pages 253-255, March.
    6. Heijink, Richard & Mosca, Ilaria & Westert, Gert, 2013. "Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands," Health Policy, Elsevier, vol. 113(1), pages 142-150.
    7. Siciliani, Luigi & Chalkley, Martin & Gravelle, Hugh, 2017. "Policies towards hospital and GP competition in five European countries," Health Policy, Elsevier, vol. 121(2), pages 103-110.
    8. Schut, Frederik T. & Varkevisser, Marco, 2017. "Competition policy for health care provision in the Netherlands," Health Policy, Elsevier, vol. 121(2), pages 126-133.
    9. Jean-Jacques Laffont & Jean Tirole, 1993. "A Theory of Incentives in Procurement and Regulation," MIT Press Books, The MIT Press, edition 1, volume 1, number 0262121743, April.
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    Cited by:

    1. Rudy Douven & Minke Remmerswaal & Ana Moura & Martin Salm, 2018. "Causes of regional variation in Dutch healthcare expenditures: evidence from movers," CPB Discussion Paper 384, CPB Netherlands Bureau for Economic Policy Analysis.
    2. Husiatyński, Maciej, 2021. "Three essays on individual behavior and new technologies," Other publications TiSEM 1a7d7036-3d54-4a7b-a425-e, Tilburg University, School of Economics and Management.
    3. Ana Moura & Martin Salm & Rudy Douven & Minke Remmerswaal, 2019. "Causes of regional variation in Dutch healthcare expenditures: Evidence from movers," Health Economics, John Wiley & Sons, Ltd., vol. 28(9), pages 1088-1098, September.

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    More about this item

    JEL classification:

    • I00 - Health, Education, and Welfare - - General - - - General
    • I11 - Health, Education, and Welfare - - Health - - - Analysis of Health Care Markets
    • L11 - Industrial Organization - - Market Structure, Firm Strategy, and Market Performance - - - Production, Pricing, and Market Structure; Size Distribution of Firms
    • L51 - Industrial Organization - - Regulation and Industrial Policy - - - Economics of Regulation

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