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Question & Answer Summary
Health system cost-reducing program underway in the Netherlands: Have
similar projects been undertaken by INAHTA members?
Date of question:
Origin of question:
December 2013
Wim Goettsch, CVZ, the Netherlands
Recently CVZ started a new program to reduce the costs of the Health care system in The
Netherlands. They would like to find organizations / persons that could help them to benchmark their
project and methodology used.
CVZ would be very interested to learn:
 if there are similar projects
 findings and results
 used methodologies and data models
 best practices
 anything else that might be relevant
Here is a short description of their program:
The Health Care Insurance Board (CVZ) started a program to further analyse the health care, as
provided within the Dutch Health Insurance Act. We call this program "Zinnig en zuinig", which can be
translated into "Sensible and economical". The purpose of this program is that we need to
systematically analyse the health care to identify costs savingsin order to maintain quality, accessibility
and future affordability. Rather than restricting access to certain elements of the health care, we
would like to develop an approach where we will find treatments which are costly and not effective, or
only effective for specific indications. Improvement of the effectivennes of health care will improve
both the individual health as well as reduce costs. We will start with data analysis (changes in
turnover, variance in costs), and a study of available literature and signals from GPs, Scientific
Organizations, Insurance companies, Patients Organizations and others. We will then match our
findings with thestakeholders and work with them to further analyse a number of these diagnoses and
treatments. If during those conversations, supported by our data analysis, savings and health care
improvements are identified, we will assist with the implementation and monitor the effectiveness of
the implementation. Recently we announced this project in the field. Currently we are discussing our
internal processes, methods and procedures.
Egon Jonsson, IHE,
IHE published this book a few years ago: IHE: Cost Containment and Efficiency in
National Health Systems. Cost Containment and Efficiency in National Health Systems: A
Global Comparison. Each chapter identifies the 4-5 specific policies with the highest
impact for ... available at the following IHE web site
There is also a very successful program in the US named “Choosing Wisely” available all
over the web.
There is also a program launched by the Ministry of Health of Alberta, named "System
wide efficiency and cost savings". I represent the IHE on the Advisory Committee of that
program. We meet quite frequently. It is essentially based on surveys to physicians and
organizations in health care to identify diagnostic and therapeutic interventions with low
or no value for the doctor or the patient, and to identify cost savings that could be
achieved immediately, in the medium term, and in the long term.
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Alun Cameron,
ASERNIP-S did do a project for the Australian Federal government in 2008 to try and
identify medical services funded through our medicare program that were
outdated/inefficient/unsafe. The overall project is summarised in the attached paper. The
rapid reviews that were associated with the project are available on our website, reports
63-67. (Note that these reports were really merely testing the usefulness of a rapid
review in answering research questions with a limited scope; they didn’t receive any
clinical input and were not used to inform any decision making). The project itself didn’t
really progress any further, although the Australian Department of Health has recently
established a framework to review services which are currently listed for medicare
rebate, in addition to an evidence-based review of new items prior to listing.
Ingrid Rosian,
Regarding the inquiry about similar projects we can report one project (I think not
directly relevant, more oganization issue) however I send you an abstract, which we have
send for HTai-conference 2014.
Cataract surgery in Austria:
A budget impact analysis of day care versus inpatient care
Ingrid Rosian-Schikuta, Herwig Ostermann, Anna-Theresa Renner
In Austrian public hospitals the most frequently performed surgical procedure is cataract
surgery. The majority of cataract surgeries are still carried out as inpatient cases with an
average length of stay of 2.3 days.
Under the current Austrian health reform inpatient services, if medically reasonable, shall
be substituted by day care to reduce health care expenditures.
Primary goal of the study is to identify and evaluate the economic effects of reallocating
even more cataract patients to day care.
The main research questions are:
Ø Is it possible to reduce health care expenditures by transferring the treatment of
cataract in adult patients from inpatient to day care and if yes, by how much?
Ø Does the organisational structure of the day care have any implications on the costs
per surgery?
To evaluate the effect of a shift from inpatient to day care a budget impact analysis from
the perspective of the hospitals was conducted. The calculations are based on
administrative data from public hospitals (costs), demographic projections and incidence
rates. To back up the economic analysis international benchmarks, systematic reviews
and medical guidelines were consulted.
Preliminary results show that increasing the share of day cases in a hospital-setting has a
considerable cost reduction potential. If cataract surgery is carried out in a dislocated day
clinic cost reductions of almost 50 % per case are feasible. However, results are subject to
significant variations in public hospitals regarding costs and service provision.
Mans Rosen. SBU
Increasing the share of cataract day cases has a high potential of reducing financial
expenditures of hospitals without compromising the service quality. On the contrary,
more patients could benefit from a cataract surgery because the frequency of the surgery
could be increased and hence waiting times could be reduced. To tap the full cost
reduction potential a restructuring of the inpatient sector for day care is essential.
At SBU, we have a database on knowledge gaps (at present 892, which can be used
for identifying research questions and identifying areas for disinvestments. As a followup, we provide some information to the health services in Sweden on areas where
disinvestment should/could be taken, e.g. corticosteroid injections for management of
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