Governing healthcare through performance measurement in Massachusetts and the Netherlands☆
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,
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Contracting treatment services in Australia: Do measures adhere to best practice?
2020, International Journal of Drug PolicyCitation Excerpt :Gaining more prominence in the literature is the use of patient reported outcome and experience measures. In a study that compared the performance measurement systems in the Netherlands and the USA, the authors reported that patient reported outcome measures have the potential to be used to look at treatment system performance and could also assist in reducing the burden of collection of data, by utilising multiple purposes (at the client, service and system levels) for use of collected data that has relevance to end users (clients, providers and funders) (Van der Wees et al., 2013). The Australian Health Performance Framework suggests that the use of patient reported outcome and experience measures be significantly expanded to allow for a ‘more systemic assessment of value in health care’ (The National Health Information & Performance Principal, 2017, p. 9).
A large group linguistic Z-DEMATEL approach for identifying key performance indicators in hospital performance management
2020, Applied Soft Computing JournalCitation Excerpt :Performance measurement plays a central role in hospital management and healthcare performance assessment has concerned more and more by the public [2–4]. An efficient and rational healthcare performance measurement system can improve medical service quality, reduce costs, optimize service processes, and achieve optimal resource allocation [5,6]. As evidence of the achievement of organizational goals, a growing number of scholars focus on the improvement of hospital management using performance indicators and many national projects have been initiated to evaluate hospital performance [7,8].
Accountability in healthcare in the Netherlands: A scoping review
2024, International Journal of Health Planning and ManagementManaged Care Models in India: An Investigation on the Ownership and Performance of Health Claims Management
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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.