Table 1 The potential of monetary incentives in cost-containment policies
Cost-containment instrument | Incentive directed at | Relevant category of care | Potential for cost-containment | Additional comments |
|---|---|---|---|---|
Fee-for-service | Providers | Outpatient and inpatient care | Low | • The upward effect of fees on costs can be neutralized, when hard budgets are introduced • The structure and level of fees in the FFS schedule can be changed for cost-containment purposes. |
Per diem payment | Providers | Inpatient care | Low | The upward effect of per diem payments on hospital costs can be neutralized, when hard hospital budgets are introduced |
Case payment | Providers | Inpatient and outpatient care | Medium | The net effect on cost-containment may be reduced by cost-shifting to other health sectors |
Capitation | Providers | Inpatient and outpatient care | Medium | The net effect on cost-containment may be reduced by cost-shifting to other health sectors |
Salaries | Providers | Inpatient and outpatient care (worktime of providers only) | High | The overall on cost-containment of national health expenditure depends on provider payment mechanisms introduced for other types of care |
Budgets | Providers | Inpatient and outpatient care | High | • The cost-containment efficiency of budgets is low, when budgets are 'soft' • Cost-shifting between sectors may reduce the overall cost-containment potential |
Patient charges | Patients | Inpatient and outpatient care | Low | Cost-reductions may be seen with important increases in patient charges, combined with the existence of medium to high price sensitivity |
Reference price system | Patients | Pharmaceuticals | Medium | Cost-containment potential will be low, when prescribing of drugs outside the reference-price system remains important |