Rendering hospital budgets volume based and open ended to reduce waiting lists: does it work?

Area of Science:

• Health Economics
• Healthcare Policy
• Hospital Management

Background:

• Global hospital budgets were replaced by output-based reimbursement in many countries to reduce patient waiting times.
• The Netherlands transitioned from fixed global budgets to volume-based, open-ended reimbursement in 2001.
• This policy aimed to improve hospital efficiency and decrease waiting lists.

Purpose of the Study:

• To evaluate the effectiveness of the Dutch policy of replacing fixed hospital budgets with volume-based reimbursement.
• To analyze the impact of this policy change on hospital admission rates and healthcare utilization.

Main Methods:

• Statistical analysis of Dutch hospital admission rate trends.
• Interpretation of data before and after the policy implementation in 2001.

Main Results:

• A significant increase in inpatient admission rates (over 3% annually) was observed post-2001, reversing a previous downward trend.
• Day care admissions, already rising, accelerated after 2001.
• Growth in admissions included observation and symptom evaluation without definitive diagnoses, and was not fully explained by population aging or pent-up demand.

Conclusions:

• Abolishing budget caps and increasing hospital activity does not guarantee equilibrium between healthcare demand and supply, as demand can be influenced by supply.
• The Dutch policy of volume-based reimbursement proved inefficient in solving waiting list problems.
• A more targeted approach, rather than a broad policy measure, is necessary for effective healthcare resource management.