title: The arduous quest for translating health care productivity gains into cost savings. Lessons from their evolution at economic scoring agencies in the Netherlands and the US.
abstract: We analyze the assessments of recent health reforms by the Congressional Budget Office (CBO) in the United States and the Bureau for Economic Policy Analysis (CPB) in the Netherlands. Both reforms aim to capitalize on productivity gains, which is appealing for policymakers because of the potential for cost savings while maintaining - or enhancing - quality and access. These measures however generally translate into more health care, rather than care that is affordable and appropriate. Scoring agencies therefore have rightfully been reluctant to assign significant savings to these measures. Thus with regard to cost savings, both agencies instead have favored more traditional policy measures in the past. They are however increasingly mapping out loose ends and dilemmas for payers, including information asymmetries, reputation issues and provider business models that contradict the goals of policymakers. This calls for further exploring this avenue and the development of more integrated agendas that might commit actors and the spread of best practices.
authors.affiliation: Faculty of Social Sciences, VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands. Electronic address: klink.ab@gmail.com.
authors.forename: Ab
authors.initials: A
authors.lastname: Klink
authors.affiliation: Celsus, Academy for Sustainable Healthcare, IQ Healthcare, Radboud University and Medical Center, P.O. Box 9101, 114 6500 HB Nijmegen, The Netherlands; NYU Wagner School of Public Service, New York University, 295 Lafayette street, 10012 New York, NY, USA. Electronic address: christiaan.schakel@radboudumc.nl.
authors.forename: H Christiaan
authors.initials: HC
authors.lastname: Schakel
authors.affiliation: Strategy&, part of the PwC Network, Thomas R. Malthusstraat 5, 1066 JT, Amsterdam, The Netherlands.
authors.forename: Sander
authors.initials: S
authors.lastname: Visser
authors.affiliation: Celsus, Academy for Sustainable Healthcare, IQ Healthcare, Radboud University and Medical Center, P.O. Box 9101, 114 6500 HB Nijmegen, The Netherlands.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jeurissen
mesh_terms: D002017:Budgets; D017046:Cost Savings / Q000191:economics*; D006077:Government Agencies; D018166:Health Care Reform / Q000191:economics*; D006297:Health Services Accessibility; D006801:Humans; D018854:Managed Competition; D009426:Netherlands; D014481:United States
keywords: Health projections; Health reform; Regulated competition; Sustainable health systems