Effects of the introduction of cost sharing in Dutch secondary mental health care

Introduction: The Dutch mental health care provision market is characterised by the presence of four financing arrangements that create four submarkets: curative care, long-term care, forensic care, and public health and community care. The market for curative care can be divided into primary care and secondary care. Furthermore, the market for secondary care can be divided into ambulatory or inpatient care. Products are described in DRGs that are defined by a combination of the diagnosis category and the amount of time spent on treatment by professionals. The price per DRG is fixed and yearly set by the DHA. Health insurance companies contract with mental health care providers. In this contact, the annual budget is set. This annual budget is determined by the amount of care provided in the previous year and by awarded points that represent the quality of care. Quality of mental health care in the Netherlands has two elements: the actual quality of care and transparency of the quality of provided health care. The actual quality of care is governed by the Health Inspectorate and also represented by certification marks. Obliging institutions to present performance indicators stimulates transparency of the quality of provided healthcare. Since the 1970s, total health care expenditure in the Netherlands as a percentage of the GDP has increased rapidly. As a response, the Dutch health care system has been subject to several reform waves. The most recent wave of reform was characterised by the introduction of regulated competition. The basis for regulated competition is secured in the HIA, which was enacted in 2006. Buying basic health insurance became mandatory for all Dutch citizens and all citizens were given equal entitlements. This was a prerequisite for introducing the most prominent demand-side rationing mechanism: societywide cost sharing. Since the introduction of regulated competition in 2006, a no-claim discount was employed. In 2008 this no-claim discount was replaced by a mandatory deductible. As of January 1st 2012, a cost-sharing scheme for secondary mental health care was implemented. Background: International research shows that an increase in price will lead to a decrease of demand for mental health care. Although price-elasticity of demand for mental health care in the Netherlands has not been researched yet, the intention of patients to continue treatment in mental healthcare after the introduction of cost sharing was subject to research by Koopmans and Verhaak (2012). They showed that 70% of the respondents that used mental health care services, intended to use less or no services after the implementation of cost sharing. Although intentions are not yet actions, this result suggests a decreasing demand for mental health care when cost sharing is introduced. When these results are compared with international research, a decrease in demand for secondary mental health care can be expected after the introduction of cost sharing. Methodology: This study consists of a literature study and a quantitative study with a quasi-experimental non-equivalent groups design. Data are collected over the years 2008, 2009, 2010, 2011 and 2012 at Bouman GGZ, an institution for mental health care and substance abuse care. Results: Data-analysis shows that the amount of opened DRGs at Bouman GGZ is significantly lower in 2012 than in other years. The populations can be considered statistically equal on the factors gender, age, and country of origin. The populations cannot be considered equal on the factors severity of mental illness and treatment reoccurrence. Conclusion: Both the literature study and the data analysis endorse the presence of a price-elasticity effect in Dutch secondary mental health care. The size of this effect is yet unknown and requires further research. The mere presence of an effect has implications for future policies; issues that should be carefully studied are: equal access to mental health care services, the presence of substitution effects, and identifying people that decide not to consume mental health care.