Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients

Milad Karimi; Apostolos Tsiachristas; Willemijn Looman; Jonathan Stokes; Mirte van Galen; Maureen Rutten-van Mölken

doi:10.1016/j.healthpol.2021.04.004

Bundled payments for chronic diseases increased health care expenditure in the Netherlands, especially for multimorbid patients

Health Policy. 2021 Jun;125(6):751-759. doi: 10.1016/j.healthpol.2021.04.004. Epub 2021 Apr 15.

Authors

Milad Karimi¹, Apostolos Tsiachristas², Willemijn Looman¹, Jonathan Stokes³, Mirte van Galen⁴, Maureen Rutten-van Mölken⁵

Affiliations

¹ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands.
² Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK.
³ Health Organisation, Policy and Economics, Primary Care and Health Services Research Centre, School of Health Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
⁴ Vektis C.V., Sparrenheuvel 18, Building B, 3708 JE Zeist, the Netherlands.
⁵ Erasmus School of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, the Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, Rotterdam, the Netherlands, PO Box 1738, 3000 DR Rotterdam. Electronic address: m.rutten@eshpm.eur.nl.

PMID: 33947604
DOI: 10.1016/j.healthpol.2021.04.004

Abstract

Bundled payments aim to stimulate the integration of healthcare services and ultimately reduce healthcare expenditure growth through improved quality of care. The Netherlands introduced bundled payments for chronic diseases in 2010 by reimbursing providers annually for a bundle of primary care services related to COPD, Diabetes, or Vascular Risk Management. We aimed to assess the long-term effects of these bundled payments on healthcare expenditure. We used health insurance claims data from 2008 to 2015 to compare the healthcare expenditure between everyone who was included in bundled payments and a control group. We performed a difference-in-difference analysis in combination with propensity score matching and found that bundled payments consistently increased health care expenditure over seven years. The average half-year increase was €233 (95%CI: 204-262) for DM2, €609 (95%CI: 533-686) for COPD, and €231 (95%CI: 208-254) for VRM, representing 13%, 52%, and 20% of 2008 half-year cost. The increase was higher for those with multimorbidity compared to those without multimorbidity. This suggests that the expectations of the bundled payments are yet to be fulfilled.

Keywords: Bundled payment; Chronic disease; Cost; Multimorbidity.

MeSH terms

Chronic Disease
Health Expenditures*
Humans
Multimorbidity
Netherlands
Patient Care Bundles*
Reimbursement Mechanisms
United States