title: Unintended effects of reimbursement schedules in mental health care.
abstract: We evaluate the introduction of a reimbursement schedule for self-employed mental health care providers in the Netherlands in 2008. The reimbursement schedule follows a discontinuous discrete step function-once the provider has passed a treatment duration threshold the fee is flat until a next threshold is reached. We use administrative mental health care data of the total Dutch population from 2008 to 2010. We find an "efficiency" effect: on the flat part of the fee schedule providers reduce treatment duration by 2 to 7% compared to a control group. However, we also find unintended effects: providers treat patients longer to reach a next threshold and obtain a higher fee. The data shows gaps and bunches in the distribution function of treatment durations, just before and after a threshold. About 11 to 13% of treatments are shifted over a next threshold, resulting in a cost increase of approximately 7 to 9%.
authors.affiliation: CPB Netherlands Bureau for Economic Policy Analysis, The Hague, The Netherlands; Erasmus University, Rotterdam, The Netherlands. Electronic address: R.Douven@cpb.nl.
authors.forename: Rudy
authors.initials: R
authors.lastname: Douven
authors.affiliation: CPB Netherlands Bureau for Economic Policy Analysis, The Hague, The Netherlands. Electronic address: M.Remmerswaal@cpb.nl.
authors.forename: Minke
authors.initials: M
authors.lastname: Remmerswaal
authors.affiliation: Ecorys, Rotterdam, The Netherlands. Electronic address: Ilaria.Mosca@ecorys.com.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Mosca
mesh_terms: D006801:Humans; D007348:Insurance, Health; D008605:Mental Health Services / Q000191:economics*; D018803:Models, Economic; D009426:Netherlands; D012051:Reimbursement Mechanisms / Q000191:economics*
keywords: Mental health care; Policy evaluation; Provider payment; Regression discontinuity design; Regulated competition; The Netherlands