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Stadhouders NW, Koolman X, Tanke MA, Maarse H, Jeurissen PP. Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands. Int J Health Policy Manag 2023; 12:7506. [PMID: 38618807 PMCID: PMC10590252 DOI: 10.34172/ijhpm.2023.7506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 08/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Purchasing systems aim to improve resource allocation in healthcare markets. The Netherlands is characterized by four different purchasing systems: managed competition in the hospital market, a non-competitive single payer system for long-term care (LTC), municipal procurement for home care and social services, and self-procurement via personal budgets. We hypothesize that managed competition and competitive payer reforms boost reallocations of provider market share by means of active purchasing, ie, redistributing funds from high-quality providers to low-quality providers. METHODS We define a Market Activity Index (MAI) as the sum of funds reallocated between providers annually. Provider expenditures are extracted from provider financial statements between 2006 and 2019. We compare MAI in six healthcare sectors under four different purchasing systems, adjusting for reforms, and market entry/exit. Next, we perform in-depth analyses on the hospital market. Using multivariate linear regressions, we relate reallocations to selective contracting, provider quality, and market characteristics. RESULTS No difference was found between reallocations in the hospital care market under managed competition and the non-competitive single payer LTC (MAI between 2% and 3%), while MAI was markedly higher under procurement by municipalities and personal budget holders (between 5% and 15%). While competitive reforms temporarily increased MAI, no structural effects were found. Relatively low hospital MAI could not be explained by market characteristics. Furthermore, the extent of selective contracting or hospital quality differences had no significant effects on reallocations of funds. CONCLUSION Dutch managed competition and competitive purchaser reforms had no discernible effect on reallocations of funds between providers. This casts doubt on the mechanisms advocated by managed competition and active purchasing to improve allocative efficiency.
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Affiliation(s)
- Niek Waltherus Stadhouders
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Xander Koolman
- School of Business and Economics, Vrije Universiteit, Amsterdam, The Netherlands
| | - Marit A.C. Tanke
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Maarse
- Department of Health Services Research, School for Public Health and Primary Care (Caphri), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Patrick P.T. Jeurissen
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
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Mazurenko O, Taylor HL, Menachemi N. The Impact of Narrow and Tiered Networks on Costs, Access, Quality, and Patient Steering: A Systematic Review. Med Care Res Rev 2022; 79:607-617. [PMID: 34753330 DOI: 10.1177/10775587211055923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Health insurers use narrow and tiered networks to lower costs by contracting with, or favoring, selected providers. Little is known about the contemporary effects of narrow or tiered networks on key metrics. The purpose of this systematic review was to synthesize the evidence on how narrow and tiered networks impact cost, access, quality, and patient steering. We searched PubMed, MEDLINE, and Cochrane Central Register of Controlled Trials databases for articles published from January 2000 to June 2020. Both narrow and tiered networks are associated with reduced overall health care costs for most cost-related measures. Evidence pertaining to access to care and quality measures were more limited to a narrow set of outcomes or were weak in internal validity, but generally concluded no systematic adverse effects on narrow or tiered networks. Narrow and tiered networks appear to reduce costs without affecting some quality measures. More research on quality outcomes is warranted.
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Affiliation(s)
| | | | - Nir Menachemi
- Indiana University, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, USA
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Onwujekwe O, Mbachu CO, Okeke C, Ezenwaka U, Ogbuabor D, Ezenduka C. Strategic Health Purchasing in Nigeria: Exploring the Evidence on Health System and Service Delivery Improvements. Health Syst Reform 2022; 8:2111785. [PMID: 35993994 DOI: 10.1080/23288604.2022.2111785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
Well-functioning purchasing arrangements allocate pooled funds to health providers, and are expected to deliver efficient, effective, quality, equitable and responsive health services and advance progress toward universal health coverage (UHC). This paper explores how improvements in purchasing functions in three Nigerian schemes-the Formal Sector Social Health Insurance Program (FSSHIP), the Saving One Million Lives Program for Results (SOML PforR), and Enugu State's Free Maternal and Child Health Program (FMCHP)-may have contributed to better resource allocation, incentives for performance, greater accountability and improved service delivery. The paper uses a case-study approach, with data analyzed using the Strategic Health Purchasing Progress Tracking Framework. Data were collected through review of program documents and published research articles, and semi-structured interviews of 33 key informant interviews. Findings were triangulated within each case study across the multiple sources of information. Improvements in benefits specification and provider payment contributed to some service delivery improvements in all three schemes: higher satisfaction with the quality of care in FSSHIP; increased use of insecticide-treated nets; greater prevention of mother-to-child HIV transmission; expanded pentavalent-3 coverage in SOML PforR; and greater service utilization in FMCHP. Resource allocation to public health facilities was enhanced and lines of accountability were better defined. These scheme-level improvements have not translated to system change, because of the small amount of funding flowing through these schemes and the high level of health financing fragmentation. The institutionalization of strategic purchasing in Nigeria to advance UHC will require raising awareness among decision makers, strengthening purchasing agencies' capacity, and reducing fragmentation.
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Affiliation(s)
- Obinna Onwujekwe
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Chinyere Ojiugo Mbachu
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Chinyere Okeke
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Uchenna Ezenwaka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Daniel Ogbuabor
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Charles Ezenduka
- Health Policy Research Group, College of Medicine, University of Nigeria, Enugu, Nigeria.,Department of Health Administration and Management, College of Medicine, University of Nigeria, Enugu, Nigeria
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Mbachu C, Okeke C, Obayi C, Gatome-Munyua A, Olalere N, Ogbonna I, Uzochukwu B, Onwujekwe O. Supporting strategic health purchasing: a case study of annual health budgets from general tax revenue and social health insurance in Abia state, Nigeria. HEALTH ECONOMICS REVIEW 2021; 11:47. [PMID: 34928450 PMCID: PMC8690461 DOI: 10.1186/s13561-021-00346-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Tracking general trends in strategic purchasing of health financing mechanisms will highlight where country demands may exist for technical support and where progress in being made that offer opportunities for regional learning. Health services in Abia State, Nigeria are funded from general tax-revenues (GTR), and a new state social health insurance scheme (SSHIS) is proposed to overcome the failings of the GTR and expand coverage of services. This study examined purchasing functions within the GTR and the proposed SSHIS to determine if the failings in GTR have been overcome, identify factors that shape health purchasing at sub-national levels, and provide lessons for other states in Nigeria pursuing a similar intervention. METHODS Data was collected through document review and key informant interviews. Government documents were retrieved electronically from the websites of different organizations. Hard copies of paper-only files were retrieved from relevant government agencies and departments. Interviews were conducted with seven key personnel of the State Ministry of Health and State Health Insurance Agency. Thematic analysis of data was based on a strategic health purchasing progress tracking framework which delves into the governance arrangements and information architecture needed for purchasing to work well; and the core purchasing decisions of what to buy; who to buy from; and how to buy. RESULTS There are differences in the purchasing arrangements of the two schemes. Purchaser-provider split does not exist for the GTR, unlike in the proposed SSHIS. There are no data systems for monitoring provider performance in the GTR-funded system, unlike in the SSHIS. Whereas GTR is based on a historical budgeting system, the SSHIS proposes to use a defined benefit package, which ensures value-for-money, as the basis for resource allocation. The GTR lacks private sector engagement, provider accreditation and contracting arrangements while the SSHIS will accredit and engage private providers through selective contracting. Likewise, provider payment is not linked to performance or adherence to established standards in the GTR, whereas provider payment will be linked to performance in the SSHIS. CONCLUSIONS The State Social Health Insurance has been designed to overcome many of the limitations of the budgetary allocation to health. This study provides insights into the enabling and constraining factors that can be used to develop interventions intended to strengthen the strategic health purchasing in the study area, and lessons for the other Nigeria states with similar characteristics and approaches.
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Affiliation(s)
- Chinyere Mbachu
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria.
| | - Chinyere Okeke
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Chinonso Obayi
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Agnes Gatome-Munyua
- Strategic Purchasing Africa Resource Center (SPARC), Nairobi, Kenya
- Results for Development (R4D), Nairobi, Kenya
| | - Nkechi Olalere
- Strategic Purchasing Africa Resource Center (SPARC), Nairobi, Kenya
| | | | - Benjamin Uzochukwu
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Community Medicine, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
- Department of Health Administration and Management, College of Medicine University of Nigeria, Ituku-Ozalla, Enugu, Nigeria
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Bilgili F, Kuşkaya S, Khan M, Awan A, Türker O. The roles of economic growth and health expenditure on CO 2 emissions in selected Asian countries: a quantile regression model approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:44949-44972. [PMID: 33852118 PMCID: PMC8045018 DOI: 10.1007/s11356-021-13639-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/22/2021] [Indexed: 05/05/2023]
Abstract
Continuous economic growth and the rise in energy consumption are linked with environmental pollution. Demand for health care expenditure increased after the COVID-19 pandemic. This study is interesting in modeling the nexus between public and private health expenditure, carbon dioxide emissions, and economic growth. To this end, the present study analyzed the nexus between public and private health care expenditure, economic growth, and environmental pollution for 36 Asian countries for the period 1991-2017. FMOLS, GMM, and quantile regression analysis confirm the EKC hypothesis in Asia. Besides, FMOLS and quantile regressions reached the reducing effects of government and private health expenditures on CO2 emissions. While quantile regression results show that public and private health expenditures can mitigate CO2 emissions; however, these results differ for various levels of CO2. Findings of quantile regression show a significant impact of both public and private health expenditures in reducing CO2 at the 50th and 75th quantiles but results are insignificant for the 25th quantile. Overall, the paper concludes that both government and private health sectors' expenditures caused CO2 emissions to decrease in Asia and that the negative impact of the private health sector on CO2 emissions is greater than that of the government health sector. The concluding remark is that the higher the health spending, the higher the environmental quality will be in Asia. Hence, the health administrators need to increase public and private health expenditures with an effective cost-service and energy-efficient management approach to reach sustainable health services and a sustainable environment in Asia.
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Affiliation(s)
- Faik Bilgili
- FEAS, Economics, Erciyes University, 38039 Kayseri, Turkey
| | - Sevda Kuşkaya
- Department of Law, Justice Vocational College, Erciyes University, 38280 Kayseri, Turkey
| | - Masreka Khan
- BRAC International, BRAC Centre, 75 Mohakhali, Dhaka, 1212 Bangladesh
| | - Ashar Awan
- The University of Azad Jammu & Kashmir – UAJ&K, University Old Campus, Muzaffarabad, 13100 Pakistan
- Social Sciences Institution, Erciyes University, 38039 Kayseri, Turkey
| | - Oguzhan Türker
- FEAS, Economics, Erciyes University, 38039 Kayseri, Turkey
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The association of socioeconomic status on treatment strategy in patients with stage I and II breast cancer in the Netherlands. Breast Cancer Res Treat 2021; 189:541-550. [PMID: 34176084 PMCID: PMC8357715 DOI: 10.1007/s10549-021-06308-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 06/20/2021] [Indexed: 11/26/2022]
Abstract
Background Previous studies have shown that socioeconomic status (SES) influences breast cancer therapy. However, these studies were performed in countries with unequal access to healthcare. Therefore, the aim of this study is to investigate whether SES also contributes to the likelihood of receiving a certain therapy in the Netherlands, a country with supposedly equal access to healthcare. Materials and methods From the Netherlands Cancer Registry, 105,287 patients with newly diagnosed stage I or II breast cancer diagnosed between 2011 and 2018 were selected for analysis. SES was calculated from the average incomes of each postal code, which were divided into 10 deciles. Primary outcome was the effect of SES on the likelihood of undergoing surgery and secondary outcome was the effect of SES on the likelihood of the type of surgery. Both outcomes were corrected for patient, tumor, and hospital characteristics and were expressed as odds ratio (OR) with 95% confidence interval (CI). Results SES did not affect the likelihood of a breast cancer patient to undergo surgery (OR 1.00 per 10% stratum). In contrast, increased age and higher tumor stage were the most important factors determining whether patients underwent surgery. Patients with higher SES were less likely to undergo mastectomy (OR 0.98). Additionally, more recently diagnosed patients were less likely to undergo mastectomy (OR 0.93 per year) while patients with higher tumor stage were more likely to undergo mastectomy (OR 3.42). Conclusion SES does not affect whether a patient undergoes surgery; however, higher SES increased the likelihood of BCT.
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Kazungu J, Kabia E, Munge K, Barasa E. Assessing the progress and gaps in strategic health purchasing in Kenya. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16606.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Kenya has committed to achieve universal health coverage (UHC) and prioritised purchasing reforms. Existing evidence indicates that purchasing can be leveraged to achieve health system objectives when done strategically. However, no single study has collated evidence on the progress and bottlenecks on strategic health purchasing (SHP) in Kenya to inform requisite SHP reforms in moving towards UHC. Against this backdrop, we assessed the progress and gaps in SHP in Kenya. Methods: We used a cross-sectional qualitative study design and collected data using document reviews, key informant interviews, and a stakeholder engagement workshop focussing on the three main purchasers in Kenya: the National Hospital Insurance Fund (NHIF), county departments of health (CDOH) and the Ministry of Health (purchaser for vertical programmes). Data was analysed following a framework analysis approach. Results: Kenya is making progress towards developing, implementing and institutionalising SHP practices that should lead to the attainment of health system goals. Progress has been made in 1) strengthening the process of defining a health benefits package available for the population, 2) engaging in selective contracting and integrated care contracting, 3) implementing multiple provider payment mechanisms, 4) designing legal and regulatory frameworks that provide direction for purchasing, and 5) increasingly utilising information systems. However, several gaps remain. First, there remain inadequate linkages between MOH policies and the NHIF that can facilitate adequate stewardship/oversight. Second, the purchasers lack adequate capacity to ensure quality assurance and enforce contracts. Third, provider payment methods (PPM) remain poorly designed, implemented, and are not adequately linked to health system goals. Finally, purchasers have weak or unclearly defined communications strategies to patients and providers. Conclusions: Although Kenya is making progress in SHP, key gaps remain. Consequently, there is a need to implement reforms that will align the purchasers’ actions and decisions to the ideals of strategic health purchasing.
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