Rijtjes healthcare purchasing - lecture 2

Purchasing stages (van Weele)

1. Tactical purchasing

   1. specifying

   2. selecting

   3. contracting

2. Operational purchasing

   1. ordering

   2. expediting

   3. follow-up

Thomson purchasing mechanisms to improve health care administration and delivery

1. Consumer mobility between insurers

2. Insurers bear financial risks —> risk -adjustment

   1. ex ante

   2. ex post

Strategies to improve the portfolio for an insurer

1. Voluntary health insurance

2. targeted marketing

3. contracting limited number of care providers

Reasons low uptake of purchasing tools

1. Legal restrictions (especially in Germany + Switzerland)

2. Consumer choices

3. Technical difficulties

4. Lack of information (quality'/costs)

5. Stakeholder resistance

Comparing purchasing countries (UK)

State-based system —> focus on cost containment and coordination

Comparing purchasing countries (NL)

market-based system —> focus on cost-control through price negotiations

Comparing purchasing countries (SW)

mixed system —> focus on collaboration

Purchaser competition

UK - low

SW - moderate

NL - high

Purchaser governance

UK - clinically informed

SW - both managerial + clinically informed

NL - managerial

Patient choice

UK - low

SW - high

NL - low to moderate