Budgetary targets as cost-containment measure in the Swiss healthcare system? Lessons from abroad. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Braendle, Thomas; Colombier, Carsten
• Is Part Of: Health policy. Volume 124:Issue 6(2020)
• Page Start: 605
• Page End: 614
• Publication Date: 2020-06
• Subjects: H51 -- I13 -- I18; Mandatory health insurance -- Cost growth -- Cost containment -- Comparative health systems -- Global budget -- Budgetary target; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2020.05.007
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: We provide a comparative analysis of social health systems with budgetary targets. Targets raise the providers' cost responsibility and their awareness for cost-benefit considerations. Clear negotiating structures and including principal healthcare players are key to success. Adjusting targets to morbidity and medical progress is necessary to avoid side-effects. Accompanying measures such as incentive-compatible remuneration schemes and quality monitoring are important. Abstract: Growing healthcare expenditure is a major concern for policy makers and calls for effective cost containment measures. For the decentralized Swiss healthcare system, ranking second among OECD countries in healthcare spending, a group of experts has proposed budgetary targets as key measure. In order to substantiate this proposal, we review the literature and analyse experiences with budgetary targets in comparable social health insurance systems, such as Germany and the Netherlands. Budgetary targets raise the cost responsibility and prompt providers to give greater weight to cost-benefit considerations. Our analysis suggests that the involvement of all principal healthcare players and clear decision-making and negotiating structures are key to successful implementation. Risks of rationing, lower quality incentives or conservation of structures have to be countered with taking into account age-related morbidity and medical progress when setting the budgetary targets. Accompanying measures such as incentive-compatible remuneration schemes and quality monitoring are of paramount importance.