Abstract
BackgroundIn 2006, the Dutch hospital market was reformed to create a more efficient delivery system through managed competition. To allow competition on quality, patient experiences were measured using the Consumer Quality index (CQI). We study whether public reporting and competition had an effect on the CQI between 2006 and 2009.MethodsWe analyzed 8,311 respondents covering 31 hospitals in 2006, 22,333 respondents covering 78 hospitals in 2007 and 24,246 respondents covering 94 hospitals in 2009. We describe CQI trends over the period 2006-2009. In addition we compare hospitals that varied in the level of competition they faced and hospitals that were forced to publish CQI results publicly and those that were not. We corrected for observable covariates between hospital respondents using a multi level linear regression. We used the Herfindahl Hirschman Index to indicate the level of competition.ResultsBetween 2006 and 2009 hospitals showed a CQI improvement of 0.034 (p < 0.05) to 0.060 (p < 0.01) points on a scale between one and four. Hospitals that were forced to publish their scores showed a further improvement of 0.027 (p < 0.01) to 0.030 (p < 0.05). Furthermore, hospitals that faced more competition from geographically close competitors showed a more pronounced improvement of CQI-scores 0.004 to 0.05 than other hospitals (p < 0.001).ConclusionOur results show that patients reported improved experiences measured by the CQI between 2006 and 2009. CQI levels improve at a faster rate in areas with higher levels of competition. Hospitals confronted with forced public publication of their CQI responded by enhancing the experiences of their patients.
Highlights
In 2006, the Dutch hospital market was reformed to create a more efficient delivery system through managed competition
In addition we investigated whether forced public reporting of hospitals and higher levels of competition–in line with previous studies and policy objectives–were associated with better patient experiences [7,9,16,17]
Our findings are as follows: First, we observe that patient experiences measured with the Consumer Quality index (CQI) improve over the course of years
Summary
In 2006, the Dutch hospital market was reformed to create a more efficient delivery system through managed competition. In the last two decades, several Western countries introduced some form of managed competition in their health care system [1,2] Common goal of these reforms is creating a demand driven system that provides more patient centered care [3]. To achieve this goal the quality of health care providers needs to be assessed and publicly reported [4,5]. The public reporting of provider quality can stimulate quality improvement through informed patient choice, We set out to answer this question in the context of the Dutch 2006 Health Insurance Act (HIA) reform. The after reform characteristics of the Dutch health can be summarized as followed: [2,10]
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