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Vijf jaar integrale bekostiging van de geboortezorg: effecten op zorggebruik, gezondheidsuitkomsten en zorguitgaven
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Series / Report no.
2023-0470
Open Access
Type
Report
Language
nl
Date
2024-04-22
Research Projects
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Journal Issue
Title
Vijf jaar integrale bekostiging van de geboortezorg: effecten op zorggebruik, gezondheidsuitkomsten en zorguitgaven
Translated Title
Five years of bundled payments for maternity care: effects on utilization, health outcomes and spending
Published in
Abstract
Het RIVM onderzoekt het effect van integrale bekostiging van de geboortezorg op zorggebruik, de gezondheidsuitkomsten en zorguitgaven. De bedoeling van deze vorm van bekostiging is het verbeteren van de kwaliteit van de geboortezorg door de samenwerking tussen verschillende zorgverleners te versterken. Hiervoor zijn in diverse regio’s zogeheten integrale geboortezorgorganisaties (igo’s) opgezet. In de igo’s is de zorg zo georganiseerd dat alle aangesloten zorgaanbieders, zoals verloskundigen, gynaecologen en kraamzorg, meer met elkaar afstemmen en samenwerken. De igo krijgt nu een bedrag voor het hele traject van de zwangerschap en geboorte en verdeelt daarna het geld over de verschillende zorgverleners. Vóór die tijd werden alle zorgverleners apart betaald.
Tussen 2017 en 2022 blijken de verschillen in het zorggebruik tussen de igo’s klein te zijn. Ook stegen de kosten van de geboortzorg iets minder voor deze periode. Verder blijkt dat de gezondheidseffecten niet zijn
veranderd, als gekeken wordt naar de resultaten bij alle igo’s samen. Het gaat daarbij onder andere om het aantal vroeggeboortes, kinderen met een laag geboortegewicht of vrouwen met een ernstige bloeding na de bevalling. Wel verschillen deze uitkomsten sterk per igo. Zo zijn bij sommige igo’s minder kinderen geboren met een laag geboortegewicht en bij anderen juist meer.
De verschillen in effecten tussen de igo’s komen onder andere doordat igo’s zelf kiezen welke interventies en veranderingen ze invoeren om de zorg te verbeteren. Dit maakt het moeilijk om het effect van integrale bekostiging op verschillende gezondheidseffecten van alle igo’s samen te meten. Daarnaast geven de igo’s zelf aan dat zij niet goed weten welke effectieve interventies er zijn en wanneer die nuttig zijn. Daarom adviseert het RIVM de igo’s
te helpen de lokale problemen beter in beeld te krijgen en hen beter te informeren welke effectieve interventies daarvoor bestaan.
In 2017 begon in opdracht van het ministerie van VWS(Ministerie van Volksgezondheid, Welzijn en Sport) integrale bekostiging als een experiment. Sinds 1 januari 2023 is het onderdeel geworden van de reguliere bekostiging. Er bestaan daardoor nu twee bekostigingsmodellen voor de geboortezorg; regio’s kiezen zelf welke zij gebruiken.
RIVM (National Institute for Public Health and the Environment) is investigating the effects of bundled payments for maternity care on maternity care utilization, health outcomes for mothers and children, and spending. The theory behind this alternative payment model is that it should improve the quality of maternity care by strengthening collaboration among the different maternity care providers. In order to implement bundled payments, a new legal entity needs to be set up in each participating region. These so-called integrated maternity care organisations (in Dutch: integrale geboortezorgorganisaties, IGOs) were voluntarily set up in various regions in the Netherlands. In these IGOs, maternity care is organised in such a way that all involved providers, such as gynaecologists, midwives and postpartum care providers, can coordinate and cooperate more effectively. The IGO negotiates a bundled fee with the health insurers, which covers the full range of maternity care services during pregnancy, delivery and the postpartum period. The IGO subsequently divides the money among the different care providers depending on the amount and type of care they provided. This model creates a more flexible reimbursement structure, compared to the traditional fee-for-service model in which maternity care providers are paid individually by the health insurers based on specific, predefined care activities. After five years of bundled payments (2017-2021), we found small differences in maternity care utilization and slower spending growth in IGOs. We found no changes in health outcomes for the IGOs combined. For preterm births, low birthweight and postpartum haemorrhaging, we found no effects for the IGOs combined but differing effects for the individual IGOs. For example, we found an increase in children born with low birthweight in some IGOs and in others we found a decrease. The differences in effects between IGOs is partly because IGOs make their own decisions on which interventions to implement and which changes to make to improve care quality. This makes it difficult to study the effect of bundled payments on various outcomes for all IGOs combined. The IGOs themselves also indicate that they do not know exactly which effective interventions are available and when they are useful in their region. This is why RIVM recommends helping the IGOs map local issues and providing better information on the effective interventions that are available for these issues. Bundled payments for maternity care were initiated in 2017 by the Ministry of Health, Welfare and Sport on an experimental and voluntary basis. It has been implemented as a regular payment model for maternity care by law since January 1, 2023. This means that there are currently two payment models for maternity care available (i.e., bundled payments and the traditional fee-for-service model), and regions can choose which one to use.
RIVM (National Institute for Public Health and the Environment) is investigating the effects of bundled payments for maternity care on maternity care utilization, health outcomes for mothers and children, and spending. The theory behind this alternative payment model is that it should improve the quality of maternity care by strengthening collaboration among the different maternity care providers. In order to implement bundled payments, a new legal entity needs to be set up in each participating region. These so-called integrated maternity care organisations (in Dutch: integrale geboortezorgorganisaties, IGOs) were voluntarily set up in various regions in the Netherlands. In these IGOs, maternity care is organised in such a way that all involved providers, such as gynaecologists, midwives and postpartum care providers, can coordinate and cooperate more effectively. The IGO negotiates a bundled fee with the health insurers, which covers the full range of maternity care services during pregnancy, delivery and the postpartum period. The IGO subsequently divides the money among the different care providers depending on the amount and type of care they provided. This model creates a more flexible reimbursement structure, compared to the traditional fee-for-service model in which maternity care providers are paid individually by the health insurers based on specific, predefined care activities. After five years of bundled payments (2017-2021), we found small differences in maternity care utilization and slower spending growth in IGOs. We found no changes in health outcomes for the IGOs combined. For preterm births, low birthweight and postpartum haemorrhaging, we found no effects for the IGOs combined but differing effects for the individual IGOs. For example, we found an increase in children born with low birthweight in some IGOs and in others we found a decrease. The differences in effects between IGOs is partly because IGOs make their own decisions on which interventions to implement and which changes to make to improve care quality. This makes it difficult to study the effect of bundled payments on various outcomes for all IGOs combined. The IGOs themselves also indicate that they do not know exactly which effective interventions are available and when they are useful in their region. This is why RIVM recommends helping the IGOs map local issues and providing better information on the effective interventions that are available for these issues. Bundled payments for maternity care were initiated in 2017 by the Ministry of Health, Welfare and Sport on an experimental and voluntary basis. It has been implemented as a regular payment model for maternity care by law since January 1, 2023. This means that there are currently two payment models for maternity care available (i.e., bundled payments and the traditional fee-for-service model), and regions can choose which one to use.
Description
Publisher
Rijksinstituut voor Volksgezondheid en Milieu RIVM