Factors Influencing Procurement of Digital Healthcare: A Case Study in Dutch District Nursing

Document Type : Original Article

Authors

1 Health Technology Assessment Unit, Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands

2 Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands

3 Department of Operations, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands

Abstract

Background 
Digital health is considered a promising solution in keeping healthcare accessible and affordable. However, implementation is often complex and sustainable funding schemes are lacking. Despite supporting policy, scaling up innovative forms of healthcare progresses much slower than intended in Dutch national framework agreements. The aim of this study is to identify factors that influence the procurement of digital health particular in district nursing.

Methods 
A case study approach was used, in which multiple stakeholder perspectives are compared using thematic framework analysis. The case studied was the procurement of digital health in Dutch district nursing. Literature on implementation of digital health, public procurement and payment models was used to build the analytic framework. We analysed fourteen interviews (secondary data), two focus groups organised by the national task force procurement and eight governmental and third-party reports.

Results 
Five themes emerged from the analysis: (1) rationale, (2) provider-payer relationship, (3) resources, (4) evidence, and (5) the payment model. Per theme a number of factors were identified, mostly related to the design and functioning of the Dutch health system and to the implementation process at providers’ side.

Conclusion 
This study identified factors influencing the procurement of digital health in Dutch district nursing. The findings, however, are not unique for digital health, district nursing or the Dutch health system. The results presented will support policy makers, and decision-makers to improve procurement of digital health. Investing in better relationships between payer and care provider organisations and professionals is an important next step towards scaling digital health.

Keywords

References

  1. Organisation for Economic Co-operation and Development (OECD). Health at a Glance 2019. Paris: OECD; 2019. doi:10.1787/4dd50c09-en
  2. Adema Y, van Tilburg I. Vergrijzingsstudie 2019: Zorgen om morgen. Centraal Planbureau (CPB); 2019.
  3. Ministerie van Volksgezondheid, Welzijn en Sport. Kamerbrief over Voortgangsrapportage Innovatie Zorgvernieuwing. kenmerk 1534848-191267-IenZ. Den Haag; 2019.
  4. Voorlopige Raad voor de Volksgezondheid en Zorggerelateerde Dienstverlening. Informatietechnologie in de zorg; advies aan de minister van Volksgezondheid, Welzijn en Sport. Zoetermeer; 1996.
  5. Krijgsman J, de Bie J, Burghouts A, et al. eHealth, verder dan je denkt: eHealth-monitor 2013. Den Haag, Utrecht: Nictiz, NIVEL; 2013.
  6. nl. Initiatief Zorg van Nu. https://www.zorgvannu.nl/over-zorg-van-nu/wat-is-zorg-van-nu. Accessed June 17, 2020.
  7. nl. Coalitie Digivaardig in de Zorg. https://www.digivaardigindezorg.nl/home/achtergrond/. Accessed June 17, 2020.
  8. Ministerie van Volksgezondheid, Welzijn en Sport. Informatie- en Communicatietechnologie (ICT) in de Zorg. Kamerstuk 27529. Den Haag; 2019.
  9. World Health Organization (WHO). WHO Guideline: Recommendations on Digital Interventions for Health System Strengthening. WHO; 2019.
  10. Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016;375(2):154-161. doi:1056/NEJMra1601705
  11. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015;2015(9):CD002098. doi:1002/14651858.CD002098.pub2
  12. Granja C, Janssen W, Johansen MA. Factors determining the success and failure of eHealth interventions: systematic review of the literature. J Med Internet Res. 2018;20(5):e10235. doi:2196/10235
  13. van der Molen L. De inzet van applicatie(s) en infrastructuur in de wijkverpleging: van wens naar realisatie. Den Haag: Nictiz; 2019.
  14. Hoofdlijnenakkoord Wijkverpleging 2019 t/m 20222018. https://www.rijksoverheid.nl/documenten/convenanten/2018/06/06/hoofdlijnenakkoord-wijkverpleging-2019-2022.
  15. Organisation for Economic Co-operation and Development (OECD), European Observatory on Health Systems and Policies. The Netherlands: Country Health Profile 2019, State of Health in de EU. Brussels: OECD Publishing, European Observatory on Health Systems and Policies; 2019. doi:1787/9ac45ee0-en
  16. van Raaij E. Purchasing Value: Purchasing and Supply Management's Contribution to Health Service Performance. Rotterdam: ERIM Inaugural Address Series Research in Management. 2016. http://hdl.handle.net/1765/93665.
  17. Nederlandse Zorgautoriteit (NZa). Wegwijzer Bekostiging Digitale Zorg 2020, Overzicht per sector. Den Haag: NZa; 2020.
  18. Forrest-Lawrence P. Case Study Research. Springer Singapore; 2019:317-331.
  19. PricewaterhouseCoopers Accountants NV. Inkoop van zorginnovatie: succes- en faalfactoren; 2018. https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/rapporten/2018/05/18/inkoop-van-zorginnovatie-succes-en-faalfactoren/inkoop-van-zorginnovatie-succes-en-faalfactoren.pdf.
  20. van Linschoten P, te Velde B. Onderzoek opschalen/delen regionale initiatieven JZOJP WV/VVT. Groningen: ARGO - University of Groningen; 2019.
  21. Nederlandse Zorgautoriteit (NZa). Monitor Contractering Wijkverpleging 2019. Den Haag: NZa; 2019.
  22. Cozijnsen M, Heida JP, Lucieer S, Stroop T. Aanbevelingen ter bevordering van gelijkgerichtheid: gelijkgerichtheid binnen het thema Juiste Zorg op de Juiste Plek. Utrecht: Strategies in Regulated Markets; 2019.
  23. Nederlandse Zorgautoriteit (NZa). Voortgangsrapportage doorontwikkeling bekostiging wijkverpleging. Den Haag: NZa; 2019.
  24. Nederlandse Zorgautoriteit (NZa). Advies bekostiging medisch-specialistische zorg: belonen van zorg die waarde toevoegt. Den Haag: NZa; 2018.
  25. Buter M, van Geest Q, Puijk L. Redenen om geen contract aan te gaan in de wijkverpleging: een verdiepend onderzoek. Arteria Consulting; 2019.
  26. Raad voor Volksgezondheid en Samenleving (RVS). Zonder context geen bewijs: over de illusie van evidence-based practice in de zorg. Den Haag: RVS; 2017.
  27. King N, Brooks J. Thematic analysis in organisational research. In: The SAGE Handbook of Qualitative Business and Management Research Methods: Methods and Challenges. SAGE Publications Ltd; 2019.
  28. Gale NK, Heath G, Cameron E, Rashid S, Redwood S. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. doi:1186/1471-2288-13-117
  29. Uyarra E, Edler J, Garcia-Estevez J, Georghiou L, Yeow J. Barriers to innovation through public procurement: a supplier perspective. Technovation. 2014;34(10):631-645. doi:1016/j.technovation.2014.04.003
  30. van Dyk L. A review of telehealth service implementation frameworks. Int J Environ Res Public Health. 2014;11(2):1279-1298. doi:3390/ijerph110201279
  31. Khoja S, Scott RE, Casebeer AL, Mohsin M, Ishaq AF, Gilani S. e-Health readiness assessment tools for healthcare institutions in developing countries. Telemed J E Health. 2007;13(4):425-431. doi:1089/tmj.2006.0064
  32. van der Hijden E, Steenhuis S, Hofstra G, et al. Ontwikkelingen in zorginkoop: van inkoop van verrichtingen naar inkoop van zorgbundels. Maandblad Voor Accountancy en Bedrijfseconomie. 2019;93(7-8):223-239. doi:5117/mab.93.33441
  33. Stokes J, Struckmann V, Kristensen SR, et al. Towards incentivising integration: a typology of payments for integrated care. Health Policy. 2018;122(9):963-969. doi:1016/j.healthpol.2018.07.003
  34. Guest G, MacQueen KM, Namey EE. Validity and reliability (credibility and dependability) in qualitative research and data analysis. In: Applied Thematic Analysis. London: SAGE Publications; 2012:79-106. doi:4135/9781483384436
  35. Noort BAC, Ahaus K, van der Vaart T, Chambers N, Sheaff R. How healthcare systems shape a purchaser's strategies and actions when managing chronic care. Health Policy. 2020;124(6):628-638. doi:1016/j.healthpol.2020.03.009
  36. Stolper KCF, Boonen L, Schut FT, Varkevisser M. Managed competition in the Netherlands: do insurers have incentives to steer on quality? Health Policy. 2019;123(3):293-299. doi:1016/j.healthpol.2018.08.018
  37. Trout KE, Rampa S, Wilson FA, Stimpson JP. Legal mapping analysis of state telehealth reimbursement policies. Telemed J E Health. 2017;23(10):805-814. doi:1089/tmj.2017.0016
  38. Bursell SE, Zang S, Keech AC, Jenkins AJ. Evolving telehealth reimbursement in Australia. Intern Med J. 2016;46(8):977-981. doi:1111/imj.13150
  39. Alami H, Gagnon MP, Wootton R, Fortin JP, Zanaboni P. Exploring factors associated with the uneven utilization of telemedicine in Norway: a mixed methods study. BMC Med Inform Decis Mak. 2017;17(1):180. doi:1186/s12911-017-0576-4
  40. Burke BL Jr, Hall RW. Telemedicine: pediatric applications. Pediatrics. 2015;136(1):e293-308. doi:1542/peds.2015-1517
  41. Georghiou L, Edler J, Uyarra E, Yeow J. Policy instruments for public procurement of innovation: choice, design and assessment. Technol Forecast Soc Change. 2014;86:1-12. doi:1016/j.techfore.2013.09.018
  42. Petsoulas C, Allen P, Hughes D, Vincent-Jones P, Roberts J. The use of standard contracts in the English National Health Service: a case study analysis. Soc Sci Med. 2011;73(2):185-192. doi:1016/j.socscimed.2011.05.021
  43. Uenk N, Telgen J. Managing challenges in social care service triads – exploring public procurement practices of Dutch municipalities. J Purch Supply Manag. 2019;25(1):5-17. doi:1016/j.pursup.2018.08.001
  44. Meehan J, Menzies L, Michaelides R. The long shadow of public policy; barriers to a value-based approach in healthcare procurement. J Purch Supply Manag. 2017;23(4):229-241. doi:1016/j.pursup.2017.05.003
  45. Miller FA, Lehoux P. The innovation impacts of public procurement offices: the case of healthcare procurement. Res Policy. 2020;49(7):104075. doi:1016/j.respol.2020.104075
  46. Groenewegen PP, Hansen J, de Jong JD. Trust in times of health reform. Health Policy. 2019;123(3):281-287. doi:1016/j.healthpol.2018.11.016
  47. Maarse H, Jeurissen P. Low institutional trust in health insurers in Dutch health care. Health Policy. 2019;123(3):288-292. doi:1016/j.healthpol.2018.12.008
  48. Steenhuis S, Struijs J, Koolman X, Ket J, E VDH. Unraveling the complexity in the design and implementation of bundled payments: a scoping review of key elements from a payer's perspective. Milbank Q. 2020;98(1):197-222. doi:10.1111/1468-0009.12438
  49. van Vooren NJE, Steenkamer BM, Baan CA, Drewes HW. Transforming towards sustainable health and wellbeing systems: Eight guiding principles based on the experiences of nine Dutch Population Health Management initiatives. Health Policy. 2020;124(1):37-43. doi:1016/j.healthpol.2019.11.003
  50. Conrad DA, Vaughn M, Grembowski D, Marcus-Smith M. Implementing value-based payment reform: a conceptual framework and case examples. Med Care Res Rev. 2016;73(4):437-457. doi:1177/1077558715615774
  51. Dohmen PJG, van Raaij EM. A new approach to preferred provider selection in health care. Health Policy. 2019;123(3):300-305. doi:1016/j.healthpol.2018.09.007
  52. Stolper KCF, Boonen L, Schut FT, Varkevisser M. Cooperation amongst insurers on enhancing quality of care: precondition or substitute for competition? Health Econ Policy Law. 2021;16(3):273-289. doi:1017/s1744133120000195
  53. Greenhalgh T, Wherton J, Papoutsi C, et al. Beyond adoption: a new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. J Med Internet Res. 2017;19(11):e367. doi:2196/jmir.8775
  54. Scott Kruse C, Karem P, Shifflett K, Vegi L, Ravi K, Brooks M. Evaluating barriers to adopting telemedicine worldwide: a systematic review. J Telemed Telecare. 2018;24(1):4-12. doi:1177/1357633x16674087
  55. Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4:50. doi:1186/1748-5908-4-50
  56. Thiel R, Deimel L, Schmidtmann D, et al. SmartHealthSystems: International Comparison of Digital Strategies. Gütersloh: Bertelsmann-Stiftung. 2019.
  57. Greenhalgh T, Russell J. Why do evaluations of eHealth programs fail? an alternative set of guiding principles. PLoS Med. 2010;7(11):e1000360. doi:1371/journal.pmed.1000360
  58. Mathews SC, McShea MJ, Hanley CL, Ravitz A, Labrique AB, Cohen AB. Digital health: a path to validation. NPJ Digit Med. 2019;2:38. doi:1038/s41746-019-0111-3
  59. Nederlandse Zorgauthoriteit (NZa). Analyse van de gevolgen van de coronacrisis voor de wijkverpleging. Den Haag: NZa; 2020.
International Journal of Health Policy and Management
Volume 11, Issue 9
September 2022
Pages 1883-1893

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History

  • Receive Date: 23 December 2020
  • Revise Date: 21 June 2021
  • Accept Date: 23 August 2021
  • First Publish Date: 29 August 2021

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