Evaluatie aanvullende en collectieve verzekeringen 2008

In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijke gevolgen van aanvullende en collectieve verzekeringen voor risicoselectie en verzekerdenmobiliteit in de basisverzekering. De analyse heeft betrekking op het jaar 2008. Tevens worden de ontwikkelingen in 2008 vergeleken met de bevindingen van voorafgaande evaluatiestudies over eerdere jaren. Het onderzoek is uitgevoerd in opdracht van de Nederlandse Patiënten Consumenten Federatie (NPCF)

Evaluatie aanvullende en collectieve ziektekostenverzekeringen 2009

Voorwoord In dit rapport wordt verslag gedaan van een onderzoek naar de mogelijke gevolgen van aanvullende en collectieve verzekeringen voor risicoselectie en verzekerdenmobiliteit in de basisverzekering. De analyse heeft betrekking op het jaar 2009. Tevens worden de ontwikkelingen in 2009 vergeleken met de bevindingen van evaluatiestudies over eerdere jaren. Het onderzoek is uitgevoerd in opdracht van de Nederlandse Patiënten Consumenten Federatie (NPCF). De auteurs danken prof. dr. W.P.M.M. van de Ven voor zijn waardevolle commentaar op een eerdere versie van dit rapport. Tevens danken zij drs. P.J. Schout van de NPCF voor haar inzet voor de totstandkoming van dit onderzoeksproject en haar betrokkenheid en commentaar

Mergers and Competition in the Dutch Healthcare Sector

Over the past 15 years, all but one hospital mergers have been granted permission by the Dutch competition authority to be consummated. Because ongoing hospital consolidation is at odds with the objectives of increased competition into the Dutch hospital market, merger activity over the past decade has fuelled a debate regarding the consequences of mergers and the desirability of further concentration. This thesis studies the effect of the introduction of price competition and merger activity in healthcare. First, the thesis studies the why and how of the several merger waves that have occurred over the past 40 years in the Dutch healthcare sector. The study suggests that over this 40-year period, government policy has focused on how to best organize and finance healthcare. At the same time, however, the underlying and structural changes that have led to the levels of concentration in today’s hospital have largely been neglected. Then, we study the impact of price liberalization on quality of care. The few available studies from other countries suggest that the relationship is negative when information on quality is poor. This thesis finds no evidence of a similar relationship in Dutch healthcare. The research does suggest that hospital mergers may lead to higher hospital prices. However, these price effects are found to be highly heterogeneous across health insurers, hospital products and hospital locations. Also, we find that merger simulation models can be used to predict these heterogeneous effects prospectively. At last, this thesis presents a survey study on the motivation for healthcare mergers. The survey was sent to the majority of Dutch healthcare executives. It was found that Dutch healthcare organizations sometimes merge for strategic reasons. Also, Dutch healthcare executives seem to have a high degree of autonomy when deciding whether or not to merge. Together with the high levels of market concentration and the potential for increased prices after merger, this finding suggests that a strict and uniform application of antitrust laws in healthcare is appropriate and warranted

Reasons for merging and collaborating in healthcare:Marriage or living apart together?

BackgroundAcross OECD countries, integration between healthcare organisations has become an indispensable part of contemporary healthcare provision. In recent years, inter-organisational collaboration has increasingly been encouraged in health and competition policy at the expense of mergers. Yet, understanding of whether healthcare organisations make an active choice between merging and collaborating is lacking. Hence, this study systematically examines (i) healthcare executives' motives for integration, (ii) their potential trade-offs between collaborating or merging, and (iii) the barriers to collaborating perceived by them.MethodsEarly 2019, an online questionnaire was conducted among a nationwide panel of 714 healthcare executives in the Netherlands. Because of their strategic position within healthcare organisations as end-responsible managers, healthcare executives are especially suited to provide broad and in-depth knowledge on the internal and external processes and decisions. Three hundred thirty-seven Dutch healthcare executives completed the questionnaire (response rate 47%). This study sample was representative of the largest healthcare sectors in the Netherlands. In total, 137 mergers and 235 inter-organisational collaborations were reported. Both closed questions and open-ended questions were systematically analysed.ResultsImproving or broadening healthcare provision is the foremost motive for mergers as well as inter-organisational collaborations. When considering both types, reducing governance complexity is one of the decisive reasons to opt for a merger, whereas aversion towards a full merger and lack of support base within the own organisation convinced healthcare executives to choose for a collaboration. When comparing specific healthcare sectors, the overlap in pursued motives and sub-motives indicates that inter-organisational collaborations and mergers are used for comparable objectives. Only a small minority of the responding executives switched between both types of integration. Institutional barriers, such as laws, regulations and financing regimes, appear to be the most restricting for healthcare executives to engage in inter-organisational collaborations.ConclusionsOur integral approach and systematic comparison across sectors could serve policymakers, regulators and healthcare providers in aligning organisational objectives and societal objectives in decision-making on collaborations and mergers. Future research is recommended to study multiple collaboration and merger cases qualitatively for a detailed examination of decision-making by healthcare executives, and develop an integral assessment framework for balancing collaborations and mergers based on their effects in the medium to long term

Does Price Competition Damage Healthcare Quality?

One of the reasons why regulators are hesitant about permitting price competition in healthcare markets is that it may damage quality when information is poor. Evidence on whether this fear is well-founded is scarce. We provide evidence using a reform that permitted Dutch health insurers and hospitals to freely negotiate prices for elective procedures. Unlike previous research that has relied on indicators of the quality of urgent treatments, we take advantage of the plausible absence of selection bias in our setting to identify the effect on quality of non-acute hip replacements. Using administrative data on all admissions to Dutch hospitals, we find no evidence that increased exposure to price competition reduces quality measured by readmission rates, despite the lack of publicly available information on this outcome. In fact, there is evidence of a temporary, positive impact on quality. Our estimated null effect over the full post-liberalization period is robust