Unintended effects of reimbursement schedules in mental health care

Rudy Douven (), Minke Remmerswaal and Ilaria Mosca
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Rudy Douven: CPB Netherlands Bureau for Economic Policy Analysis
Ilaria Mosca: Ecorys

No 292, CPB Discussion Paper from CPB Netherlands Bureau for Economic Policy Analysis

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 prolong treatment only if marginal benefits to patients outweigh marginal costs. We estimate a reduction in treatment duration by 2 to 6% and lower costs by 3 to 5% 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. In total, about 11 to 13% of treatments are shifted to over a next threshold, resulting in a cost increase of approximately 7 to 8%.

JEL-codes: I11 I12 I18 (search for similar items in EconPapers)
Date: 2014-11
New Economics Papers: this item is included in nep-eur and nep-hea
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