Regional variation in health care substitution for intrauterine device insertion: a retrospective cohort study.

Background: Rising health care costs are a major concern in most Western countries. The substitution of healthcare stands as a strategic approach aimed at mitigating costs while offering medical services in proximity to patients' residences. An illustrative instance involves the migration of outpatient hospital care to primary care settings.

Regional practice variation in hysterectomy and the implementation of less invasive surgical procedures: A register-based study in the Netherlands.

Introduction: Many women experience bleeding disorders that may have an anatomical or unexplained origin. Although hysterectomy is the most definitive and common treatment, it is highly invasive and resource-intensive. Less invasive therapies are therefore advised before hysterectomy for women with fibroids or bleeding disorders.

Do women living in a deprived neighborhood have higher maternity care costs and worse pregnancy outcomes? A retrospective population-based study.

Background: Living in a deprived neighborhood is associated with poorer health, due to factors such as lower socio-economic status and an adverse lifestyle. There is little insight into whether living in deprived neighborhood is associated with adverse maternity care outcomes and maternity health care costs. We expect women in a deprived neighborhood to experience a more complicated pregnancy, with more secondary obstetric care (as opposed to primary midwifery care) and higher maternity care costs.

Passing on the hot potato. Dutch municipalities under financial pressure have incentives to shift the costs of social care for older people to the central government.

In view of the impending ageing of the population, countries have been searching for ways to restructure their social care system. Reforms often involve a decentralisation of authority from central to local government. Although such a decentralisation presents the opportunity to be receptive to social demand, it could provide the incentive for local governments that bear the burden of the costs to (partly) transfer their costs back to the central level.

The height premium: A systematic review and meta-analysis.

The taller people are, the more money they tend to earn. This phenomenon is widely known as the height premium. However, it is not yet known whether the height premium is universal, or whether it varies by context.

Practice variation in the stepped care approach to idiopathic heavy menstrual bleeding: A population-based study.

Introduction: Heavy menstrual bleeding (HMB) affects a quarter of all women, with half having no structural cause. Dutch guidelines recommend a stepped care approach to the management of such idiopathic HMB, starting with medication or a levonorgestrel-releasing intrauterine device (LNG-IUD), before progressing to endometrial ablation, and ultimately, hysterectomy. However, practice variation between hospitals could lead to suboptimal health outcomes and increased healthcare costs for some women.

Do patients' preferences prevail in hospital selection?: a comparison between discrete choice experiments and revealed hospital choice.

Background: In patient choice, patients are expected to select the provider that best fits their preferences. In this study, we assess to what extent the hospital choice of patients in practice corresponds with their preferred choice.

Methods: Dutch patients with breast cancer (n = 631) and cataract (n = 1109) were recruited.

The potential risk of using historic claims to set bundled payment prices: the case of physical therapy after lower extremity joint replacement.

Background: One of the most significant challenges of implementing a multi-provider bundled payment contract is to determine an appropriate, casemix-adjusted total bundle price. The most frequently used approach is to leverage historic care utilization based on claims data. However, those claims data may not accurately reflect appropriate care (e.

Is paternal height related to fertility outcomes? Evidence from the Netherlands during the secular growth trend.

Over the past two centuries, the Dutch experienced a tremendous secular trend in height, and ultimately became the tallest nation in the world. Improving environmental conditions likely played the largest role in explaining these developments. But it is not yet precisely clear what factor set the Dutch head and shoulders above other nations, who were also experiencing improving environmental conditions.

How important is income in explaining individuals having forgone healthcare due to cost-sharing payments? Results from a mixed methods sequential explanatory study.

Background: Patients having forgone healthcare because of the costs involved has become more prevalent in recent years. Certain patient characteristics, such as income, are known to be associated with a stronger demand-response to cost-sharing. In this study, we first assess the relative importance of patient characteristics with regard to having forgone healthcare due to cost-sharing payments, and then employ qualitative methods in order to understand these findings better.

On the correlation between outcome indicators and the structure and process indicators used to proxy them in public health care reporting.

Hospital quality indicators provide valuable insights for quality improvement, empower patients to choose providers, and have become a cornerstone of value-based payment. As outcome indicators are cumbersome and expensive to measure, many health systems have relied on proxy indicators, such as structure and process indicators. In this paper, we assess the extent to which publicly reported structure and process indicators are correlated with outcome indicators, to determine if these provide useful signals to inform the public about the outcomes.

Height and marital outcomes in the Netherlands, birth years 1841-1900.

Adult body height appears to be significantly associated with marital outcomes: taller men across contexts have been found to be more likely to be married, and more likely to be married at younger ages. We are interested in exploring both outcomes individually and simultaneously, while using an unique, individual-level dataset of Dutch men and their brothers born between 1841 and 1900. To do so, we exploit survival models and cure models.

On selecting quality indicators: preferences of patients with breast and colon cancers regarding hospital quality indicators.

Background: There is an increasing number of quality indicators being reported publicly with aim to improve the transparency on hospital care quality. However, they are little used by patients. Knowledge on patients' preferences regarding quality may help to optimise the information presented to them.

Global budget versus cost ceiling: a natural experiment in hospital payment reform in the Netherlands.

Global budget (GB) arrangements have become a popular method worldwide to control the rise in healthcare expenditures. By guaranteeing hospital funding, payers hope to eliminate the drive for increased production, and incentivize providers to deliver more efficient care and lower utilization. We evaluated the introduction of GB contracts by certain large insurers in Dutch hospital care in 2012 and compared health care utilization to those insurers who continued with more traditional production-based contracts, i.

Practice variation in long-term care access and use: The role of the ability to pay.

Practice variation in publicly financed long-term care (LTC) may be inefficient and inequitable, similarly to practice variation in the health care sector. Although most OECD countries spend an increasing share of their gross domestic product on LTC, it has received comparatively little attention to date compared with the health care sector. This paper contributes to the literature by assessing and comparing regional practice variation in both access to and use of institutional LTC and investigating its relation with income and out-of-pocket payment.

Adult body height as a mediator between early-life conditions and socio-economic status: the case of the Dutch Potato Famine, 1846-1847.

Adult body height appears to be a relatively accurate summary variable of early-life exposures' influence on health, and may be a useful indicator of health in populations where more traditional health-related indicators are lacking. In particular, previous studies have shown a strong, positive relationship between environmental conditions in early life (particularly nutritional availability and the disease environment) and adult height. Research has also demonstrated positive associations between height and socioeconomic status.

The effect of cost-sharing design characteristics on use of health care recommended by the treating physician; a discrete choice experiment.

Background: Cost-sharing programs are often too complex to be easily understood by the average insured individual. Consequently, it is often difficult to determine the amount of expenses in advance. This may preclude well-informed decisions of insured individuals to adhere to medical treatment advised by the treating physician.

The total value of time of children undergoing treatment: A contingent valuation from the perspective of parents in the orthopaedic department of a Dutch hospital.

Aim: Children spend substantial amounts of time receiving medical care (patients' time), and this patients' time plays an important role in parental choices for paediatric care. However, it is usually ignored in economic evaluations. This is a concern because economic evaluations are increasingly being used to inform child health policy decision-making.

Good, better, best? A comprehensive comparison of healthcare providers' performance: An application to physiotherapy practices in primary care.

Most payment methods in healthcare stimulate volume-driven care, rather than value-driven care. Value-based payment methods such as Pay-For-Performance have the potential to reduce costs and improve quality of care. Ideally, outcome indicators are used in the assessment of providers' performance.

Attributing a monetary value to patients' time: A contingent valuation approach.

It is hard to ignore the importance of patient time investment in the production of health since the influential paper by Grossman (1972). Patients' time includes time to admission, travel time, waiting time, and treatment time and can be substantial. Patients' time is, however, often ignored in economic analyses.

Practice variation in the Dutch long-term care and the role of supply-sensitive care: Is access to the Dutch long-term care equitable?

Universal access and generous coverage are important goals of the Dutch long-term care (LTC) system. It is a legal requirement that everyone eligible for LTC should be able to receive it. Institutional care (IC) made up for 90% of Dutch LTC spending.

Sociodemographic Differences in the Use of Electronic Nicotine Delivery Systems in the European Union.

Introduction: Electronic nicotine delivery systems (ENDS) are rapidly increasing in popularity. However, little is known about sociodemographic differences in use of ENDS. This study aims to assess the sociodemographic characteristics associated with ENDS ever-use and use as a cessation tool in the European Union.

Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.

Background And Objectives: The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs.

Early life undernutrition and chronic diseases at older ages: the effects of the Dutch famine on cardiovascular diseases and diabetes.

Nutritional conditions in early life may causally affect health at older ages. This paper examines the effects of early life exposure to the Dutch famine (Winter 1944-45) on the prevalence of heart diseases, peripheral arterial diseases (PAD) and diabetes mellitus (DM) at ages 60-76. Analyses are performed using data from the fifth cycle of the Longitudinal Aging Study Amsterdam.