Why Substantial Budget Reallocations Are Not and Should Not Be a Major Factor in Active Purchasing in Dutch Healthcare; Comment on “Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands”

Articles in Press

Document Type : Commentary

Author

School of Economics, Utrecht University, Utrecht, The Netherlands

Abstract

This commentary discusses the study by Stadhouders et al, which analyzes budget reallocations among Dutch healthcare providers as a result of one form of active purchasing. The study assumes that healthcare purchasers aim to shift substantial funds from inefficient to efficient providers, yet finds little evidence of such shifts. This commentary explains more explicitly why substantial volume shifts are not and should not be a major factor in the Dutch context, citing factors such as the scarcity of underperforming providers, strong regional dependencies, data quality limitations, and patient reluctance to change provider. More promising avenues for active purchasing include fostering active collaboration and improving contractual arrangements. 

Keywords

References

  1. Stadhouders NW, Koolman X, Tanke MAC, Maarse H, Jeurissen PPT. 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. doi:34172/ijhpm.2023.7506
  2. van de Ven WP, Schut FT. Universal mandatory health insurance in the Netherlands: a model for the United States? Health Aff (Millwood). 2008;27(3):771-781. doi:1377/hlthaff.27.3.771
  3. Reactie NVZ volumenormen: Betekenisvolle stap voor de gezondheidszorg. 2025. https://nvz-ziekenhuizen.nl/actualiteit-en-opinie/volumenormen.
  4. IGJ. 2020 in vogelvlucht. 2021. Annual report IGJ. https://www.igj.nl/publicaties/jaarverslagen/2021/02/12/jaarverslag-2020-in-vogelvlucht.
  5. Shmueli A, Stam P, Wasem J, Trottmann M. Managed care in four managed competition OECD health systems. Health Policy. 2015;119(7):860-873. doi:1016/j.healthpol.2015.02.013
  6. Jeurissen P, Maarse H. The market reform in Dutch health care: Results, lessons and prospects. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2021. European Observatory Health Policy Series.
  7. de Jong JD, van den Brink-Muinen A, Groenewegen PP. The Dutch health insurance reform: switching between insurers, a comparison between the general population and the chronically ill and disabled. BMC Health Serv Res. 2008;8:58. doi:1186/1472-6963-8-58
  8. Uenk N. Commissioning of Social Care Services: Municipal commissioning approaches for social care services – evidence from a countrywide live experiment [Dissertation]. Utrecht University Repository; 2019
  9. Camboni R, Corazzini L, Galavotti S, Valbonesi P. Bidding on price and quality: an experiment on the complexity of scoring rule price auctions. Rev Econ Stat. 2025;107(3):755-770. doi:1162/rest_a_01288
  10. Klasa K, Greer SL, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Health Policy. 2018;122(5):457-472. doi:1016/j.healthpol.2018.01.014
  11. Telgen J, Uenk N, Lohmann W. Gemeenten Als Opdrachtgever. LUCIDE. 2014;3:59-63. doi:1007/s40408-014-0059-y
  12. Hoogenraad W, Knight L, Uenk N. Onderzoek naar effecten inkoopsystematiek op kosten jeugdzorg: Minder aanbieders verlaagt kosten jeugdzorg niet [Dutch]. Deal! April 2023.  
  13. Noort O, Schotanus F. A comparative analysis of the effectiveness of traditional and shared savings contracts for home care services. Journal of Public Procurement. 2025. doi:1108/JOPP-04-2024-0032
  14. Tip B, Uenk N, Schotanus F. Barriers and Enablers of value-based procurement in Dutch healthcare providers. Int J Health Policy Manag. 2025;14:8514. doi:34172/ijhpm.8514
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 12 August 2025

Files

History

  • Received Date: 26 March 2025
  • Revised Date: 10 August 2025
  • Accepted Date: 11 August 2025
  • First Published Date: 12 August 2025

Share

How to cite

Statistics