Effective healthcare cost-containment policies: A systematic review

Niek Stadhouders, Florien Kruse, Marit Tanke, Xander Koolman, Patrick Jeurissen

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Unsustainable growth in healthcare expenditure demands effective cost-containment policies. We review policy effectiveness using total payer expenditure as primary outcome measure. We included all OECD member states from 1970 onward. After a rigorous quality appraisal, we included 43 original studies and 18 systematic reviews that cover 341 studies. Policies most often evaluated were payment reforms (10 studies), managed care (8 studies) and cost sharing (6 studies). Despite the importance of this topic, for many widely-used policies very limited evidence is available on their effectiveness in containing healthcare costs. We found no evidence for 21 of 41 major groups of cost-containment policies. Furthermore, many evaluations displayed a high risk of bias. Therefore, policies should be more routinely and rigorously evaluated after implementation. The available high-quality evidence suggests that the cost curve may best be bent using a combination of cost sharing, managed care competition, reference pricing, generic substitution and tort reform.
Original languageEnglish
Pages (from-to)71-79
Number of pages9
JournalHealth Policy
Volume123
Issue number1
Early online date2 Nov 2018
DOIs
Publication statusPublished - Jan 2019

Keywords

  • Cost containment
  • Health reform
  • Healthcare costs
  • Policy evaluation
  • Systematic review

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