IDEAS home Printed from https://ideas.repec.org/a/wly/hlthec/v30y2021i10p2399-2408.html
   My bibliography  Save this article

Have Dutch Hospitals Saved Lives and Reduced Costs? A longitudinal patient‐level analysis over the years 2013–2017

Author

Listed:
  • Sandra Sülz
  • Holger Wagenaar
  • Joris van de Klundert

Abstract

The purpose of this paper is to shed light on the ongoing Dutch health system reforms and identify whether hospital costs and hospital outcomes have changed over time. We present an empirical analysis that is based on granular micro‐costing data and focuses on conditions for which mortality is indicative of outcome quality, that is, acute myocardial infarction (AMI), chronic heart failure (CHF), and pneumonia (PNE). We deploy a dataset of more than 80,000 inpatient episodes over 5 years (2013–2017) to estimate regression models that control for variation between patients and hospitals. We have three main findings. First, our results do not indicate significant outcome improvements over the years; that is, there is no time trend for mortality. Second, there is heterogeneity in cost developments: for patients who survive their inpatient stay, our data indicate that costs increase significantly by 0.9% per year for AMI patients, while costs decrease significantly by 1.7% per year for CHF patients and by 1.9% per year for PNE patients. For patients who pass away during their inpatient stay, our data do not indicate significant time trends. Third and finally, our results suggest the existence of substantial cost variation between hospitals.

Suggested Citation

  • Sandra Sülz & Holger Wagenaar & Joris van de Klundert, 2021. "Have Dutch Hospitals Saved Lives and Reduced Costs? A longitudinal patient‐level analysis over the years 2013–2017," Health Economics, John Wiley & Sons, Ltd., vol. 30(10), pages 2399-2408, September.
  • Handle: RePEc:wly:hlthec:v:30:y:2021:i:10:p:2399-2408
    DOI: 10.1002/hec.4391
    as

    Download full text from publisher

    File URL: https://doi.org/10.1002/hec.4391
    Download Restriction: no

    File URL: https://libkey.io/10.1002/hec.4391?utm_source=ideas
    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
    ---><---

    References listed on IDEAS

    as
    1. Michael K. Chapko & Chuan‐Fen Liu & Mark Perkins & Yu‐Fang Li & John C. Fortney & Matthew L. Maciejewski, 2009. "Equivalence of two healthcare costing methods: bottom‐up and top‐down," Health Economics, John Wiley & Sons, Ltd., vol. 18(10), pages 1188-1201, October.
    2. Unto Häkkinen & Gunnar Rosenqvist & Tor Iversen & Clas Rehnberg & Timo T. Seppälä & on behalf of the EuroHOPE study group, 2015. "Outcome, Use of Resources and Their Relationship in the Treatment of AMI, Stroke and Hip Fracture at European Hospitals," Health Economics, John Wiley & Sons, Ltd., vol. 24(S2), pages 116-139, December.
    3. 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.
    4. R. Halbersma & M. Mikkers & E. Motchenkova & I. Seinen, 2011. "Market structure and hospital–insurer bargaining in the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(6), pages 589-603, December.
    5. Josephine C. Jacobs & Paul G. Barnett, 2017. "Emergent Challenges in Determining Costs for Economic Evaluations," PharmacoEconomics, Springer, vol. 35(2), pages 129-139, February.
    6. Douven, Rudy & Burger, Monique & Schut, Frederik, 2020. "Does managed competition constrain hospitals' contract prices? Evidence from the Netherlands," Health Economics, Policy and Law, Cambridge University Press, vol. 15(3), pages 341-354, July.
    7. Häkkinen, Unto & Rosenqvist, Gunnar & Peltola, Mikko & Kapiainen, Satu & Rättö, Hanna & Cots, Francesc & Geissler, Alexander & Or, Zeynep & Serdén, Lisbeth & Sund, Reijo, 2014. "Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals," Health Policy, Elsevier, vol. 117(1), pages 15-27.
    8. Y. J. F. M. Krabbe-Alkemade & T. L. C. M. Groot & M. Lindeboom, 2017. "Competition in the Dutch hospital sector: an analysis of health care volume and cost," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 139-153, March.
    9. Drummond, Michael F. & Sculpher, Mark J. & Claxton, Karl & Stoddart, Greg L. & Torrance, George W., 2015. "Methods for the Economic Evaluation of Health Care Programmes," OUP Catalogue, Oxford University Press, edition 4, number 9780199665884.
    10. Grégoire Mercier & Gérald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," Post-Print hal-01829947, HAL.
    11. S. Tan & F. Rutten & B. Ineveld & W. Redekop & L. Hakkaart-van Roijen, 2009. "Comparing methodologies for the cost estimation of hospital services," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 10(1), pages 39-45, February.
    12. Roos, Anne-Fleur & O’Donnell, Owen & Schut, Frederik T. & Van Doorslaer, Eddy & Van Gestel, Raf & Varkevisser, Marco, 2020. "Does price deregulation in a competitive hospital market damage quality?," Journal of Health Economics, Elsevier, vol. 72(C).
    13. J. Oostenbrink & F. Rutten, 2006. "Cost assessment and price setting of inpatient care in the Netherlands. The DBC case-mix system," Health Care Management Science, Springer, vol. 9(3), pages 287-294, August.
    14. Gregoire Mercier & Gerald Naro, 2014. "Costing Hospital Surgery Services: The Method Matters," PLOS ONE, Public Library of Science, vol. 9(5), pages 1-7, May.
    15. Martin van Ineveld & Jeroen van Wijngaarden & Gerard Scholten, 2018. "Choosing cooperation over competition; hospital strategies in response to selective contracting," International Journal of Health Planning and Management, Wiley Blackwell, vol. 33(4), pages 1082-1092, October.
    Full references (including those not matched with items on IDEAS)

    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. Peter Dohmen & Martin Ineveld & Aniek Markus & Liana Hagen & Joris Klundert, 2023. "Does competition improve hospital performance: a DEA based evaluation from the Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(6), pages 999-1017, August.
    2. Zuzana Špacírová & David Epstein & Leticia García-Mochón & Joan Rovira & Antonio Olry de Labry Lima & Jaime Espín, 2020. "A general framework for classifying costing methods for economic evaluation of health care," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 21(4), pages 529-542, June.
    3. Lucy Cunnama & Edina Sinanovic & Lebogang Ramma & Nicola Foster & Leigh Berrie & Wendy Stevens & Sebaka Molapo & Puleng Marokane & Kerrigan McCarthy & Gavin Churchyard & Anna Vassall, 2016. "Using Top‐down and Bottom‐up Costing Approaches in LMICs: The Case for Using Both to Assess the Incremental Costs of New Technologies at Scale," Health Economics, John Wiley & Sons, Ltd., vol. 25(S1), pages 53-66, February.
    4. Vogl, Matthias, 2013. "Improving patient-level costing in the English and the German ‘DRG’ system," Health Policy, Elsevier, vol. 109(3), pages 290-300.
    5. Raulinajtys-Grzybek, Monika, 2014. "Cost accounting models used for price-setting of health services: An international review," Health Policy, Elsevier, vol. 118(3), pages 341-353.
    6. Malgorzata Cyganska & Piotr Cyganski & Chris Pyke, 2019. "Development of clinical value unit method for calculating patient costs," Health Economics, John Wiley & Sons, Ltd., vol. 28(8), pages 971-983, August.
    7. Bugge, Christoffer & Sæther, Erik Magnus & Brustugun, Odd Terje & Kristiansen, Ivar Sønbø, 2021. "Societal cost of cancer in Norway –Results of taking a broader cost perspective," Health Policy, Elsevier, vol. 125(8), pages 1100-1107.
    8. Eric French & Elaine Kelly & Pieter Bakx & Owen O'Donnell & Eddy Doorslaer, 2016. "Spending on Health Care in the Netherlands: Not Going So Dutch," Fiscal Studies, Institute for Fiscal Studies, vol. 37, pages 593-625, September.
    9. Chandeni S. Gajadien & Peter J. G. Dohmen & Frank Eijkenaar & Frederik T. Schut & Erik M. Raaij & Richard Heijink, 2023. "Financial risk allocation and provider incentives in hospital–insurer contracts in The Netherlands," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(1), pages 125-138, February.
    10. de Vries, Hein & Vahl, Jos & Muris, Jean & Evers, Silvia & van der Horst, Henriëtte & Cheung, Kei Long, 2021. "Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts," Health Policy, Elsevier, vol. 125(1), pages 27-33.
    11. Chiara Brouns & Rudy Douven & Ron Kemp, 2021. "Prices and market power in mental health care: Evidence from a major policy change in the Netherlands," Health Economics, John Wiley & Sons, Ltd., vol. 30(4), pages 803-819, April.
    12. Abdelbaste Hrifach & Coralie Brault & Sandrine Couray-Targe & Lionel Badet & Pascale Guerre & Christell Ganne & Hassan Serrier & Vanessa Labeye & Pierre Farge & Cyrille Colin, 2016. "Mixed method versus full top-down microcosting for organ recovery cost assessment in a French hospital group," Health Economics Review, Springer, vol. 6(1), pages 1-7, December.
    13. Y. J. F. M. Krabbe-Alkemade & T. L. C. M. Groot & M. Lindeboom, 2017. "Competition in the Dutch hospital sector: an analysis of health care volume and cost," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(2), pages 139-153, March.
    14. Adam D M Briggs & Peter Scarborough & Jane Wolstenholme, 2018. "Estimating comparable English healthcare costs for multiple diseases and unrelated future costs for use in health and public health economic modelling," PLOS ONE, Public Library of Science, vol. 13(5), pages 1-14, May.
    15. Eva Glaeser & Bart Jacobs & Bernd Appelt & Elias Engelking & Ir Por & Kunthea Yem & Steffen Flessa, 2020. "Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia—A Prerequisite for Efficient and Fair Comprehensive Obstetric Care," IJERPH, MDPI, vol. 17(21), pages 1-15, November.
    16. Anne-Fleur Roos & Eddy van Doorslaer & Owen O'Donnell & Erik Schut & Marco Varkevisser, 2018. "Does price competition damage healthcare quality?," Tinbergen Institute Discussion Papers 18-040/V, Tinbergen Institute.
    17. Sonila M. Tomini & Efthalia Massou & Nadia E. Crellin & Naomi J. Fulop & Theo Georghiou & Lauren Herlitz & Ian Litchfield & Pei Li Ng & Chris Sherlaw-Johnson & Manbinder S. Sidhu & Holly Walton & Step, 2024. "A Cost Evaluation of COVID-19 Remote Home Monitoring Services in England," PharmacoEconomics - Open, Springer, vol. 8(5), pages 739-753, September.
    18. Alexander V van Schoonhoven & Judith J Gout-Zwart & Marijke J S de Vries & Antoinette D I van Asselt & Evgeni Dvortsin & Pepijn Vemer & Job F M van Boven & Maarten J Postma, 2019. "Costs of clinical events in type 2 diabetes mellitus patients in the Netherlands: A systematic review," PLOS ONE, Public Library of Science, vol. 14(9), pages 1-22, September.
    19. Darcy M. Anderson & Ryan Cronk & Lucy Best & Mark Radin & Hayley Schram & J. Wren Tracy & Jamie Bartram, 2020. "Budgeting for Environmental Health Services in Healthcare Facilities: A Ten-Step Model for Planning and Costing," IJERPH, MDPI, vol. 17(6), pages 1-22, March.
    20. 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.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    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:wly:hlthec:v:30:y:2021:i:10:p:2399-2408. See general information about how to correct material in RePEc.

    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: Wiley Content Delivery (email available below). General contact details of provider: http://www3.interscience.wiley.com/cgi-bin/jhome/5749 .

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

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.