Wednesday, February 27, 2013

Are Price Controls the Answer? Netherlands Edition

This post is co-authored with Misja Mikkers, who is Director of Strategy and Legal Affairs at the Netherlands Healthcare Authority and is affiliated with Tilburg University, the Netherlands and Copenhagen Business School, Denmark.
 
In a previous post one of us (Gaynor) examined some evidence on whether price controls are effective in slowing the rate of growth of health care spending, and how they compare with competition in private markets. In this post we examine some evidence from the Netherlands that may bear on the matter. In the previous post a data point from the Netherlands was shown as part of an international comparison, but it’s worthwhile to examine the Netherlands experience a bit further. The Netherlands is particularly interesting because they have employed rate setting in health care and subsequently deregulated much of their health sector to allow prices to be market determined. The question of whether the end of rate setting and the introduction of competition raised or lowered health care costs and prices in the Netherlands is hotly debated.

The article by Steven Brill in Time also led also to a lot of discussion in the Netherlands. Rob Wijnberg (former editor of the important Dutch Newspaper NRC-next) tweeted, “brilliant article about the reasons why competition in health care doesn’t work" (https://twitter.com/robwijnberg, Feb 26, translation M. Mikkers). 

Health reform in the Netherlands has been gradual and has had a number of different elements. Initially competition in health insurance was introduced (with an individual mandate), while maintaining rate setting for providers. A partial and gradual deregulation of provider prices followed. For hospitals some services have been deregulated (this is called the B Segment) and some services remain under price controls (the A Segment). The proportion of services in the deregulated B Segment has increased over time. In 2005 8% of hospital services were in the B-segment. This percentage then increased to 20% and 30% in 2008 and 2009 respectively. In 2012 virtually all elective care (70% of hospital services) was in the B segment.

The figure below (source: Market Scan Hospital Market 2011, Netherlands Healthcare Authority [in Dutch]) shows the percentage change in hospital prices over time in the price controlled A Segment and deregulated B Segment. As can be seen, growth in the deregulated segment, where prices are market determined, is substantially lower from about 2006-2007 onwards. In fact, from about 2008-2009 to 2010-2011 prices were falling in the deregulated segment while they were still growing in the price controlled segment. This doesn’t necessarily mean that competition controls prices and rate setting does not (lots of other things could be going on), but neither do we see what we’d expect if rate setting was doing a superior job of controlling prices.
The next figure (below, source: CBS [Dutch Central Bureau of Statistics] ) shows the growth rate in hospital spending in the Netherlands in the period before rate deregulation (2001-2005) and after deregulation began (2006-2011). The average annual growth rates between the two periods are virtually indistinguishable. Again, this isn’t scientific proof that rate setting doesn’t control costs (either in general or in the Netherlands), but there’s no slam dunk for rate setting in the patterns that we observe. We may be able to see more interesting patterns in the future. By 2014 and 2015 virtually all prices for elective care will have been deregulated and all parties in the market will be fully exposed to the consequences of their (price) negotiations.  



In sum, the Netherlands is a good place to look for the effects of rate setting versus markets on prices and spending, since they have employed both. A quick look at some descriptive statistics doesn’t yield any slam dunks for rate setting. If anything, shifting to markets may have substantially reduced price growth. However, careful study will be required in order to draw firmer conclusions. Last, while we believe that there are lessons for the US from experiences in other countries (and vice versa), we do have to be cautious in making strong inferences across very different health care systems and societies.

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    ReplyDelete
  27. Private Lender Avit Investment Authority.
    Greetings to you by ADIA.
    We are a France-Paris based investment company known as Avit
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    We would be happy to fund and invest with you in any profitable
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    on:avitinvestmentauthority2@gmail.com for more details.
    Looking forward hearing from you soonest.
    Yours truly,
    Mrs Rose Williams
    (Personal Assistant)
    Avit Development Investment Authority(ADIA)
    501 Avenue Montaigne,75008 Paris-France
    Paris-France.Avit Development Investment Authority (ADIA)

    ReplyDelete
  28. Hello,

    This is to inform the general public that Pastor God'stime Alisha, a private lender loan has opened an economic opportunity for those in need of any financial help. We give out loans to individuals, businesses and companies in a clear and understandable terms and conditions of the interest rate of just 3%. contact us today via e-mail:(pastorgodtimeloanfirm6@gmail.com), so that we can give you our loan terms and conditions.

    Borrower INFORMATION

    1) Name: .............................................. .........
    2) Country: .............................................. ...........
    3) Address: .............................................. ............
    4) Member: .............................................. ..............
    5) Sex: .............................................. ..................
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    Contact:(pastorgodtimeloanfirm6@gmail.com)

    Thanks,
    Pastor God'stime Alisha

    ReplyDelete
  29. Good Day Sir/Madam: Do you need an urgent loan to finance your business or in any purpose? We are certified and legitimate and international licensed loan lender we offer loans to Business firms. Individuals, companies firms, corporate bodies at an affordable interest rate of 3%. It might be a short or long term loan or even if you have poor credit. We shall process your loan as soon as we receive your application. We are an independent financial institution. We have built up an excellent reputation over the years in providing various types of loans to thousands of our customers. We offer Educational loan, Business loan, home loan, Agricultural loan, Personal loan, Auto loan with either a good or bad credit history. If you are interested in our above loan offer you are advice to fill the below information and return to us for more details. You can contact us with this email (standardonlineinvestment@gmail.com) we shall respond to you as soon as we receive your loan application details below.

    First name:
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    Regards,
    Mr Abdul Muqse

    ReplyDelete
  30. My Brothers and Sister all over the world, I am Mrs Boo Wheat from Canada ; i was in need of loan some month ago. i needed a loan to open my restaurant and bar, when one of my long time business partner introduce me to this good and trustful loan lender DR PURVA PIUS that help me out with a loan, and is interest rate is very low , thank God today. I am now a successful business woman, and I became useful. In the life of others, I now hold a restaurant and bar. And about 30 workers, thank GOD for my life I am leaving well today a happy father with three kids, thanks to you DR PURVA PIUS Now I can take care of my lovely family, i can now pay my bill. I am now the bread winner of my family. If you are look for a trustful and reliable loan leader. You can Email him via,mail (urgentloan22@gmail.com) Please tell him Mrs Boo Wheat from Canada introduce you to him. THANKS

    ReplyDelete
  31. We Offer Private, Commercial and Personal Loans with very Minimal annual Interest Rates as Low as 3% . We give out loans within the range of $1,000 to $100,000,000.If you are interested reply me now.Contact us via Email: capitalfundings3@gmail.com

    ReplyDelete
  32. We Offer Private, Commercial and Personal Loans with very Minimal annual Interest Rates as Low as 3% . We give out loans within the range of $1,000 to $100,000,000.If you are interested reply me now.Contact us via Email: capitalfundings3@gmail.com

    ReplyDelete
  33. Hello Everybody,
    My name is Mrs Sharon Sim. I live in Singapore and i am a happy woman today? and i told my self that any lender that rescue my family from our poor situation, i will refer any person that is looking for loan to him, he gave me happiness to me and my family, i was in need of a loan of S$250,000.00 to start my life all over as i am a single mother with 3 kids I met this honest and GOD fearing man loan lender that help me with a loan of S$250,000.00 SG. Dollar, he is a GOD fearing man, if you are in need of loan and you will pay back the loan please contact him tell him that is Mrs Sharon, that refer you to him. contact Dr Purva Pius,via email:(urgentloan22@gmail.com) Thank you.

    BORROWERS APPLICATION DETAILS


    1. Name Of Applicant in Full:……..
    2. Telephone Numbers:……….
    3. Address and Location:…….
    4. Amount in request………..
    5. Repayment Period:………..
    6. Purpose Of Loan………….
    7. country…………………
    8. phone…………………..
    9. occupation………………
    10.age/sex…………………
    11.Monthly Income…………..
    12.Email……………..

    Regards.
    Managements
    Email Kindly Contact: (urgentloan22@gmail.com)

    ReplyDelete
  34. Hello Everybody,
    My name is Mrs Sharon Sim. I live in Singapore and i am a happy woman today? and i told my self that any lender that rescue my family from our poor situation, i will refer any person that is looking for loan to him, he gave me happiness to me and my family, i was in need of a loan of S$250,000.00 to start my life all over as i am a single mother with 3 kids I met this honest and GOD fearing man loan lender that help me with a loan of S$250,000.00 SG. Dollar, he is a GOD fearing man, if you are in need of loan and you will pay back the loan please contact him tell him that is Mrs Sharon, that refer you to him. contact Dr Purva Pius,via email:(urgentloan22@gmail.com) Thank you.

    ReplyDelete
  35. Do you need Personal Loan?
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    ReplyDelete
  36. We Offers Financial Consulting To Client, Companies Seeking Debt / Loan Financing And Seeking For Working Capital To Start A New Business Or To Expand Existing Business. Interested Parties Should Contact Us For More Information Through Via E-mail: SuiteCapitals@gmail.com ( SuiteCapitals@post.com )

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    ReplyDelete