title: Using the deductible for patient channeling: did preferred providers gain patient volume?
abstract: In market-based health care systems, channeling patients to designated preferred providers can increase payer's bargaining clout, other things being equal. In the unique setting of the new Dutch health care system with regulated competition, this paper evaluates the impact of a 1-year natural experiment with patient channeling on providers' market shares. In 2009 a large regional Dutch health insurer designated preferred providers for two different procedures (cataract surgery and varicose veins treatment) and gave its enrollees a positive financial incentive for choosing them. That is, patients were exempted from paying their deductible when they went to a preferred provider. Using claims data over the period 2007-2009, we apply a difference-in-difference approach to study the impact of this channeling strategy on the allocation of patients across individual providers. Our estimation results show that, in the year of the experiment, preferred providers of varicose veins treatment on average experienced a significant increase in patient volume relative to non-preferred providers. However, for cataract surgery no significant effect is found. Possible explanations for the observed difference between both procedures may be the insurer's selection of preferred providers and the design of the channeling incentive resulting in different expected financial benefits for both patient groups.
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands. vandergeest@bmg.eur.nl.
authors.forename: Stéphanie A
authors.initials: SA
authors.lastname: van der Geest
authors.affiliation: Institute of Health Policy and Management (iBMG), Erasmus University Rotterdam, P.O. Box 1738, 3000 DR, Rotterdam, The Netherlands.
authors.forename: Marco
authors.initials: M
authors.lastname: Varkevisser
mesh_terms: D002387:Cataract Extraction / Q000191:economics / Q000706:statistics & numerical data; D003669:Deductibles and Coinsurance / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D009426:Netherlands; D011243:Preferred Provider Organizations / Q000706:statistics & numerical data*; D014648:Varicose Veins / Q000191:economics / Q000628:therapy
keywords: Difference-in-difference; Patient channeling; Preferred providers