title: Measuring Healthcare Providers' Performances Within Managed Competition Using Multidimensional Quality and Cost Indicators.
abstract: OBJECTIVE
  The Dutch healthcare system is in transition towards managed competition. In theory, a system of managed competition involves incentives for quality and efficiency of provided care. This is mainly because health insurers contract on behalf of their clients with healthcare providers on, potentially, quality and costs. The paper develops a strategy to comprehensively analyse available multidimensional data on quality and costs to assess and report on the relative performance of healthcare providers within managed competition.
  
  
  METHODS
  We had access to individual information on 2409 clients of 19 Dutch diabetes care groups on a broad range of (outcome and process related) quality and cost indicators. We carried out a cost-consequences analysis and corrected for differences in case mix to reduce incentives for risk selection by healthcare providers.
  
  
  CONCLUSIONS
  There is substantial heterogeneity between diabetes care groups' performances as measured using multidimensional indicators on quality and costs. Better quality diabetes care can be achieved with lower or higher costs. Routine monitoring using multidimensional data on quality and costs merged at the individual level would allow a systematic and comprehensive analysis of healthcare providers' performances within managed competition.
authors.affiliation: Department of Health Sciences, VU University, Amsterdam, The Netherlands.
authors.forename: France R M
authors.initials: FR
authors.lastname: Portrait
authors.affiliation: Achmea, Amersfoort, The Netherlands.
authors.forename: Onno
authors.initials: O
authors.lastname: van der Galiën
authors.affiliation: Centre for Health Economics, University of York, York, UK.
authors.forename: Bernard
authors.initials: B
authors.lastname: Van den Berg
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000592:standards; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D005260:Female; D018166:Health Care Reform; D006282:Health Personnel / Q000191:economics / Q000592:standards*; D006801:Humans; D007348:Insurance, Health; D008297:Male; D018854:Managed Competition / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands; D019984:Quality Indicators, Health Care
keywords: costs; diabetes mellitus type 2; health system reform; healthcare providers' performance; integrated care; managed competition; multidimensional quality