Health insurance outcome-based purchasing: The case of hospital contracting for cardiac interventions in the Netherlands

ABSTRACT

Innovative forms of value-based purchasing contracts, based on outcome instead of volume, are imperative to face the imminent cost crisis in health care. The objective of this study was to design and implement a model for an outcome-based purchasing contract between a hospital and a health insurance company. The model was implemented in 2015. A study cohort (n = 14,944) from patients with coronary artery disease or atrial fibrillation treated in 2014 was compared to a historical reference cohort from patients treated between 2010 and 2013. The outcome measures and the model are based on Porter's value-based healthcare principles. Improvements in outcomes were observed, leading to a financial incentive to be spent on further quality improvement. Implementation of this model is a first step towards enabling inclusion of patient-relevant outcomes in purchasing for healthcare. It aligns the focus of health insurance companies and hospitals on patient value.

KEYWORDS:

• Quality
• outcomes
• healthcare systems
• outcome-based payments
• value-based purchasing
• value-based healthcare

Acknowledgements

The authors wish to thank Saskia Houterman for her statistical advice.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

D. N. Schulz http://orcid.org/0000-0002-1016-432X

F. van Eenennaam http://orcid.org/0000-0003-1768-4552

M.A. Soliman Hamad http://orcid.org/0000-0002-2298-7702