Effective healthcare cost-containment policies: A systematic review. Issue 1 (January 2019) - Stadhouders, Niek
Highlights: We review effectiveness of cost containment policies on a payer level. We included 43 original studies and 18 reviews covering 341 studies. Evidence gaps were identified in 21 of 41 categories. Quality appraisal selected 13 studies with low risk of bias. Cost sharing, managed care, reference pricing and generic substitution are effective. Abstract: Unsustainable growth in healthcare expenditure demands effective cost-containment policies. We review policy effectiveness using total payer expenditure as primary outcome measure. We included all OECD member states from 1970 onward. After a rigorous quality appraisal, we included 43 original studies and 18 systematic reviews that cover 341 studies. Policies most often evaluated were payment reforms (10 studies), managed care (8 studies) and cost sharing (6 studies). Despite the importance of this topic, for many widely-used policies very limited evidence is available on their effectiveness in containing healthcare costs. We found no evidence for 21 of 41 major groups of cost-containment policies. Furthermore, many evaluations displayed a high risk of bias. Therefore, policies should be more routinely and rigorously evaluated after implementation. The available high-quality evidence suggests that the cost curve may best be bent using a combination of cost sharing, managed care competition, reference pricing, generic substitution and tort reform.