Effects of regulated competition on key outcomes of care: Cataract surgeries in the Netherlands

Abstract

Similar to several other countries, the Netherlands implemented market-oriented healthcare reforms in recent years. Previous studies raised questions on the effects of thesereforms on key outcomes such as quality, costs, and prices. The empirical evidence is up tonow mixed. This study looked at the variation in prices, volume, and quality of cataract sur-geries since the introduction of price competition in 2006. We found no price convergenceover time and constant price differences between hospitals. Quality indicators generallyshowed positive results in cataract care, though the quality and scope of the indicatorswas suboptimal at this stage. Furthermore, we found limited between-hospital variation inquality and there was no clear-cut relation between prices and quality. Volume of cataractcare strongly increased in the period studied. These findings indicate that health insurersmay not have been able to drive prices down, make trade-offs between price and quality,and selectively contract health care without usable quality information. Positive resultscoming out from the 2006 reform should not be taken for granted. Looking forward, futureresearch on similar topics and with newer data should clarify the extent to which thesefindings can be generalized.