Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation; Comment on “Competition in Healthcare: Good, Bad or Ugly?”

Document Type: Commentary

Authors

1 NZa, Dutch Healthcare Authority, Utrecht, The Netherlands

2 Free University of Amsterdam, Amsterdam, The Netherlands

3 TILEC, Tilburg University, Tilburg, The Netherlands

4 Centre for Health Policy and Management, Trinity College Dublin, Dublin 2, Ireland

Abstract

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems. Arguably, in a competitive, multi-payer environment, contractual innovation may occur more rapidly than in a single-payer system. This innovation in contract design could enhance performance. However, contractual innovation often fails to improve performance as payer incentives are misaligned with public policy objectives. Numerous countries seek to improve healthcare contracts, but thus far no health system has demonstrably crafted the necessary blend of incentives to stimulate optimal contracting.

Keywords

Main Subjects


  1. Havighurst CC. Health care choices: private contracts as instruments of health reform. American Enterprise Institute; 1995.
  2. Goddard M. Competition in healthcare: good, bad or ugly? Int J Health Policy Manag. 2015;4(9):567-569. doi:10.15171/ijhpm.2015.144
  3. Robinson JC. Theory and practice in the design of physician payment incentives. Milbank Q. 2001;79(2):149-177. doi:10.1111/1468-0009.00202
  4. Douven R, Mocking R, Mosca I. The effect of physician remuneration on regional variation in hospital treatments. Int J Health Econ Manag. 2015;15(2):215-240. doi:10.1007/s10754-015-9164-2
  5. Roberts M, Hsiao W, Berman P. Getting Health Reform Right: A Guide to Improving Performance And Equity. Oxford University press; 2008.
  6. Ryan P. Transforming primary care in Ireland: information, incentives, and provider capabilities. Centre for Health Policy and Management Working Paper (01); 2011.
  7. Nederlandse Zorgautoriteit. Marktscan en Beleidsbrief. Ketenzorg 2014. Weergave van de markt 2008-2013. http://www.nza.nl/104107/105773/953131/Marktscan_Ketenzorg_2014_en_beleidsbrief.pdf. Accessed September 15, 2015. Published 2015.
  8. Mikkers M, Ryan P. “Managed competition” for Ireland? The single versus multiple payer debate. BMC Health Serv Res. 2014;14:442. doi:10.1186/1472-6963-14-442
  9. Cutler D, Wikler E, Basch P, et al. Reducing administrative costs and improving the health care system. N Engl J Med. 2012;367(20):1875-1878. doi:10.1056/NEJMp1209711
  10. Jost TS. Health insurance exchanges: legal issues. J Law Med Ethics. 2009;37(s2):51-70. doi:10.1111/j.1748-720x.2009.00420.x
  11. Rajkumar R, Press MJ, Conway PH. The CMS Innovation Center--a five-year self-assessment. N Engl J Med. 2015;372(21):1981-1983. doi:10.1056/NEJMp1501951