Abstract
Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods: The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results: Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions: This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery.
Highlights
Healthcare systems worldwide strive to improve the quality of care, while experiencing a growing need to curb the increasing healthcare costs.[1]
The majority of independent treatment centre (ITC) are affiliated to a chain (50%-62%), with chain affiliation rates being especially high for ITCs performing total knee replacement (TKR) and total hip replacement (THR)
general hospital (GH) perform better on process and structure indicators (Table S1), as illustrated by the average index measure being negative for ITCs and positive for GHs
Summary
Healthcare systems worldwide strive to improve the quality of care, while experiencing a growing need to curb the increasing healthcare costs.[1] As a response, governments aim to improve quality and reduce costs simultaneously.[2,3] One of the proposed solutions is the reallocation of ambulatory care from general hospitals (GHs) to independent treatment centres (ITCs).[4,5]. ITCs are a growing phenomenon in many healthcare systems. Due to the increasing significance of ITC care, it is important to study cost- and quality differences between ITC care and GH care, and investigate how this is supported within a regulated competition healthcare system
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