Elsevier

Health Policy

Volume 116, Issue 1, May 2014, Pages 18-26
Health Policy

Governing healthcare through performance measurement in Massachusetts and the Netherlands

https://doi.org/10.1016/j.healthpol.2013.09.009Get rights and content

Abstract

Massachusetts and the Netherlands have implemented comprehensive health reforms, which have heightened the importance of performance measurement. The performance measures addressing access to health care and patient experience are similar in the two jurisdictions, but measures of processes and outcomes of care differ considerably. In both jurisdictions, the use of health outcomes to compare the quality of health care organizations is limited, and specific information about costs is lacking. New legislation in both jurisdictions led to the establishment of public agencies to monitor the quality of care, similar mandates to make the performance of health care providers transparent, and to establish a shared responsibility of providers, consumers and insurers to improve the quality of health care.

In Massachusetts a statewide mandatory quality measure set was established to monitor the quality of care. The Netherlands is stimulating development of performance measures by providers based on a mandatory framework for developing such measures. Both jurisdictions are expanding the use of patient-reported outcomes to support patient care, quality improvement, and performance comparisons with the aim of explicitly linking performance to new payment incentives.

Introduction

Massachusetts and the Netherlands each implemented system-wide health reforms in 2006 [1], [2]. With a population of 6.5 million, Massachusetts’ reforms in 2006 achieved near-universal insurance coverage through increased public insurance for low-income residents and increased private coverage for middle and higher-income residents [2]. In August 2012 a law was enacted to reduce the growth in health care costs while also improving health care quality. Under supervision of a Health Policy Commission and informed by a new Center for Health Information and Analysis, Massachusetts is poised to address these challenges with a variety of performance measures [3]. As Massachusetts implements the blueprint that guides the new national health care reform in the United States, many eyes are focused on its efforts to improve quality and contain costs.

The reforms in the Netherlands, with 16.7 million residents, moved from a predominantly public insurance system with universal coverage toward a regulated privatized market system. In the beginning of 2012 the Minister of Healthcare announced the establishment of the Dutch Quality Institute to coordinate the monitoring of quality, accessibility and affordability of health care in the Netherlands.

A key component of the reforms in both jurisdictions has been the establishment of regulated competitive insurance markets, which include a marketplace (called an “exchange” in the United States) where individuals and employers can compare and purchase health insurance plans. In addition, the reforms aim to establish regulated competitive markets for health insurance purchasing and health care provision. Regulated competition assumes that if these markets work properly, they will improve the quality of care and contain costs through increased efficiency [4].

The reforms increase the importance of performance measurement and reporting to support consumers in making informed decisions and to provide leverage for insurers as competitive purchasers. It offers comparative information to health care providers, enabling them to benchmark their performance relative to other providers. The goals of performance measurement in this context are twofold: to promote accountability to the public and to improve the performance of the health system [5]. In this article we compare performance measurement in the health care systems of Massachusetts and the Netherlands. Our aim is to use this comparison to derive lessons about the challenges of using performance measurement to improve quality and to discuss three main avenues for addressing these challenges. First we describe the governance in both jurisdictions for monitoring the performance of the health care system. Second, we compare the availability of performance measures in Massachusetts and the Netherlands: what measures are available, by whom they are developed, collected and presented, and for what purposes. We limit our comparisons to publicly accessible performance measures in both jurisdictions. Third, we compare existing evidence on the actual use of quality measures in Massachusetts and the Netherlands for choosing providers and health plans, and for performance-based contracting.

Section snippets

Comparative framework

Performance measurement and reporting can occur at different levels and have different purposes, with consequences for the choice of measures and how they are collected and presented [6]. Health system performance can be used at several levels that reflect differing interactions between participants in the health care system. Clinicians may use quality measures to assess individual interactions with patients and for quality improvement within their organizations. Comparisons of the performance

Governance of health care system performance

Performance information is essential for the regulatory role of government to monitor the overall quality of the health care system. Specifically, monitoring can assure a level playing field to guide market competition among health plans and among health care organizations [7]. The governments in Massachusetts and the Netherlands established public agencies to stimulate more timely and comprehensive monitoring of safety, quality, and effectiveness of healthcare, and to allow for linking these

Availability of quality measures

Quality measures are derived from data collected via patients, health care providers and health plans. Patient-reported, clinical and administrative data are then used to quantify the quality of a selected aspect of care. Requirements for validity and reliability are high when using quality measures for accountability, and data are expected to be collected through standardized and detailed specifications [6]. In both jurisdictions quality measure sets have been developed to allow for the

Quality improvement

Many health care organizations and providers use quality indicators for quality improvement activities, although this type of use rarely results in publicly available information [27]. Structural capabilities intended to improve quality of care among physician groups in Massachusetts, such as frequent meetings to discuss quality and physician awareness of patient experience ratings, have been associated with better performance [28], [29]. The majority of Massachusetts physician groups that

Implications for future policy

The recent developments in Massachusetts and the Netherlands to stimulate performance measurement share many similarities, but also some important differences. We highlight lessons in four key areas of future policy: (1) governance of performance measurement, (2) availability of quality measures, (3) the use of quality measures, and (4) integration of data collection.

Conclusion

The Massachusetts Health Policy Commission and the Dutch Quality Institute share a similar mandate to monitor the quality of the health care system. Both jurisdictions rely on and should further invest in engagement of and partnership with patients, health care providers and insurers in order to establish reliable and meaningful quality monitoring systems. The main challenges are (a) to create a routine flow of data collection that allows for use at the clinical level and quality improvement,

References (58)

  • W.P. van de Ven et al.

    Universal mandatory health insurance in the Netherlands: a model for the United States?

    Health Affairs

    (2008)
  • J.E. McDonough et al.

    Massachusetts health reform implementation: major progress and future challenges

    Health Affairs

    (2008)
  • J.Z. Ayanian et al.

    Tackling rising health care costs in Massachusetts

    New England Journal of Medicine

    (2012)
  • A.C. Enthoven

    The history and principles of managed competition

    Health Affairs

    (1993)
  • P.C. Smith et al.

    Performance measurement for health system improvement: experiences, challenges and prospects. European Osservatory on Health Systems and Policies

    (2009)
  • L.A. Gardner et al.

    Leveraging improvement in quality and value in health care through a clinical performance measure framework: a recommendation of the American College of Physicians

    American Journal of Medical Quality

    (2010)
  • E. van Ginneken et al.

    Implementing insurance exchanges – lessons from Europe

    New England Journal of Medicine

    (2012)
  • SQAC (Statewide Quality Advisory Committee)

    Year 1 final report

    (2012)
  • An Act to promote cost containment, transparency and efficiency in the provision of quality health insurance for...
  • Massachusetts Healthcare Quality Partners (MHQP)

    Quality insights: healthcare performance in Massachusetts

    (2013)
  • DHCFP

    Measuring health care quality and cost in Massachusetts

    (2009)
  • Zichtbare Zorg. Available from: http://www.zichtbarezorg.nl/page/Programma-Zichtbare-Zorg;...
  • Inspectie voor de Gezondheidszorg: Kwaliteitsindicatoren;...
  • G. Westert et al.

    Dutch health care performance report

    (2010)
  • D.M.J. Delnoij et al.

    Made in the USA: the import of American Consumer Assessment of Health Plan Surveys (CAHPS®) into the Dutch social insurance system

    European Journal of Public Health

    (2006)
  • D. de Boer et al.

    The discriminative power of patient experience surveys

    BMC Health Services Research

    (2011)
  • B.E. Landon

    Use of quality indicators in patient care: a senior primary care physician trying to take good care of his patients

    JAMA: The Journal of the American Medical Association

    (2012)
  • T. Freeman

    Using performance indicators to improve health care quality in the public sector: a review of the literature

    Health Services Management Research: An Official Journal of the Association of University Programs in Health Administration/HSMC, AUPHA

    (2002)
  • National Quality Measures Clearinghouse. Agency for Healthcare Research and Quality (AHRQ). Available from:...
  • CBO

    Handleiding Indicatorontwikkeling

    (2008)
  • Massachusetts Health Care Quallity and Cost Council

    My health care options

    (2013)
  • Kiesbeter.nl. Available from: http://www.kiesbeter.nl/zorg-en-kwaliteit/zoek-op-kwaliteit/;...
  • NIAZ

    Accreditation of hospitals

    (2012)
  • Commonwealth Health Insurance Connector Authority. Available from:...
  • DHCFP

    Guide to managed care in Massachusetts

    (2011)
  • M. Hendriks et al.

    Dutch healthcare reform: did it result in performance improvement of health plans? A comparison of consumer experiences over time

    BMC Health Services Research

    (2009)
  • P.S. Hussey et al.
  • M.W. Friedberg et al.

    Readiness for the Patient-Centered Medical Home: structural capabilities of Massachusetts primary care practices

    Journal of General Internal Medicine

    (2009)
  • M.W. Friedberg et al.

    Associations between structural capabilities of primary care practices and performance on selected quality measures

    Annals of Internal Medicine

    (2009)
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    Disclosure: Dr. Van der Wees and Dr. Van Ginneken are supported by a Harkness Fellowship in Health Policy and Practice from the Commonwealth Fund. The views presented here are those of the authors and should not be attributed to The Commonwealth Fund or its directors, officers, or staff. Dr. Ayanian is supported by the Health Disparities Research Program of Harvard Catalyst/The Harvard Clinical and Translational Science Center (NIH Award #UL1 RR 025758 and financial contributions from Harvard University and its affiliated academic health care centers). The sponsors did not have a role in the study design, data collection and analysis, or writing of the report.

    1

    Scientific Institute for Quality of Healthcare, Radboud University Medical Center, P.O. BOX 9101, 6500 HB Nijmegen, the Netherlands.

    2

    Tel.: +31 24 361 5305; fax: +31 24 354 0166.

    3

    Present address: Berlin University of Technology, Department of Health Care Management, Straße des 17. Juni 135, 10623 dBerlin, Germany.

    4

    Tel.: +1 617 432 3455; fax: +1 617 432 0173.

    5

    Tel.: +1 617 338 2059; fax: +1 617 357 7470.

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