SiRM | Strategies in Regulated Markets

Our goal is to contribute to quality, accessibility and affordability in the markets in which operate. We, therefore, devote time and attention to disseminating our ideas and analyses, provided, of course, they are not confidential. Please find a selection of publications by the SiRM team below.

Risk adjustment in long-term care Piet Stam, Jan-Peter Heida, Lieke Boonen and Xander Koolman	SiRM has supported the Dutch organization of Health Insurers (ZN) to determine to what extent a model of ex-ante risk equalization can be obtained in long-term care (AWBZ). Furthermore, to the extent that it proved unfeasible in the short run, SiRM examined what it takes to create such a model.
Updating Pharmacy-based Cost Groups (PCGs) Piet Stam and Lieke Boonen	SiRM has helped the Dutch Ministry of Health, Welfare and Sports with their biyearly check of the PCG-classification of Dutch insured individuals in the risk equalization model. Based on medical and economic arguments, the medical expert meetings as organized by SiRM came up with an advice to change the PCG-classification as of 2012.
SiRM in Medisch Contact Renske Kok	Dutch hospital care is unique in Europe, above all because of small volume. Although amendals are cut more frequently in the Netherlands, all other services are provided relatively prudent compared to their colleagues elsewhere. You can download the pdf of this (Dutch) article here.
Invitational conference NVZ Jan-Peter Heida	On November 24, 2010, SiRM organized the substantive aspects of an ‘invitational conference’ of the NVZ (Dutch Association of Hospitals) regarding distribution and concentration of hospital functions.
Performance indicators and Bayesian statistics Xander Koolman, Dika Luijendijk and Lieke Boonen	SiRM has found that the statistical reliability of care-related indicators can be greatly improved using Bayesian statistics. The improvement over and above traditional frequentist statistics is strongest for health care providers with a small number of patients and with indicators that are highly sensitive to chance. SiRM therefore advises the Dutch Health Care Transparency Programme (Zichtbare Zorg) to use Bayesian statistics if the statistical reliability of performance indicators is limited.
Elsevier’s The Best Hospitals 2010 Jan-Peter Heida, Jan Sonneveld en Lieke Boonen	SiRM has supported Elsevier weekly in its study on The Best Hospitals 2010 based on performance indicators and other publicly available data on Dutch hospitals. Performance indicators were selected for the study, as well as care-related indicators, such as information on waiting times, on the financial situation of a hospital and on patient experiences (CQ-Index).
NVZ Industry Report on General Hospitals 2010 Jan-Peter Heida en Renske Kok	The benefits from only eight treatments already exceed the costs for all treatments together in general hospitals. This is apparent from the industry report ‘Care for benefits’ published by the Dutch Association of Hospitals NVZ written in cooperation with SiRM. This report also indicates that, in comparison with the rest of Europe, the Netherlands only spends 3.7% of its GDP on hospital care. The eight countries that surround us spend at least 0.5% more.
The Netherlands spends relatively little on hospital care Jan-Peter Heida en Renske Kok	The number of doctors, consultations, hospital beds and operations per capita in the Dutch population is relatively low. So the Netherlands spends relatively little on hospitals and doctors (general practitioners) - 3.8% of GDP. This has come to the fore through a comparison with eight other Western European countries that SiRM conducted for the NVZ. You can listen to the interview (in Dutch) with Jan-Peter Heida on May 19, 2010 that Radio 1 broadcast, here duration: 4 minutes 14 seconds).
Insights into quality can increase dynamics in the health insurance market Jan-Peter Heida, Piet Stam en Lieke Boonen	The fact that there is little differentiation between the policies of health insurance companies does not mean that efforts are not being expended in this regard, such as on the development of reliable and comprehensible information for consumers on the quality of care. You can download the expanded version of the condensed FD article on the Care & Market page of December 1, 2009 (all in Dutch).
Health insurers struggle with a confidence problem Lieke Boonen	Effective purchase of care by insurers is hampered by a growing problem of confidence among the insured. This problem can only be effectively countered by improving the public accessibility of information on the quality of care. This is according to Lieke Boonen, who has written an article in the Dutch biweekly magazine for economists called ESB in cooperation with Erik Schut. You will need an expanded subscription to ESB in order to use their archives.
The regional market power of care groups causes concern Marja Appelman	Implementation of Diagnosis and Treatment Combination chains promotes continuity of care for the chronically ill via care groups. There are risks too, however. In many regions, for instance, there is only one care group, resulting in problems of competition for places. An article in the Dutch biweekly magazine for economists called ESB by Marja Appelman, written in conjunction with Marco Varkevisser, Stéphanie van der Geest and Jeroen Struijs raises this issue. You will need an expanded subscription to ESB in order to use their archives.
Roadmap to more reliable performance indicators Xander Koolman	The statistical reliability of performance indicators is of great value to users of the information. While still limited, it can be improved easily in many cases. This is the main conclusion from a background study that SiRM has been commissioned to conduct by the Dutch Health Care Transparency Programme (Zichtbare Zorg).
NVZ Industry Report on General Hospitals 2009 Jan-Peter Heida en Renske Kok	A general trend toward quality improvement can be perceived in Dutch hospitals. This is apparent from the industry report ‘Focus on confidence’ published by the Dutch Association of Hospitals (NVZ) written in cooperation with SiRM. The hospitals are also showing good performance indicators with respect to productivity.
The CQ-Index and the purchase of care Piet Stam	As buyers of care, healthcare insurers can use the CQ-Index, amongst others, to investigate whether their insured are getting adequate value for their premiums. Care providers can also use this instrument as a starting point for internal improvement approaches.
Performance based financing of physiotherapy Piet Stam (for Agis Zorgverzekeringen)	Outpatient physiotherapy is the first sector which involves free pricing. Since 2009, a Dutch insurer has been using this freedom to link financial consequences to measured quality differences amongst first line physiotherapists. As a component in a careful, multi-year implementation of the so-called pay-for-performance concept, the CQ-Index, RAND-36 and PSK together determine the difference in quality.
Training of Romanian regulator Jan-Peter Heida	In mid-April of 2008, presentations were provided to the Romanian regulator of gas and electricity, ANRE. A training course was offered to ANRE staff and a seminar was organized by key players in the electricity and gas sectors.
The right measure Jan-Peter Heida en Xander Koolman	Information is lost by publishing quality indicators in the AWBZ (Exceptional Medical Expenses Act) by ‘organizational unit’. Study for ZBTK (Care-wide transparency and quality)
The ‘hard core’ of risk equalization Piet Stam	The Dutch system of risk equalization is advanced, but still not perfect. This ESB article shows that there is a ‘hard core’ of insured parties who will predictably incur losses. At the same time, this finding offers starting points for improving risk equalization. You can also download the Dutch report on which the ESB article is based and the expanded summary in English setting out the major conclusions.
Willingness to pay of insured individuals in good and poor health Piet Stam	In this scientific study, a fee analysis shows that young, healthy insured parties, too, are prepared to pay for insurance products that result in better quality of care. But the added value must be made explicit. This confirms the importance of transparent quality indicators.
Report figures on health care in 56 countries made comparable Renske Kok	It was shown in an international comparison that, in an identical process of care-giving, patient experience was assessed more positively by Greeks than by the Dutch. These subjective responses can become comparable by applying the so-called HOPIT method.
Negotiating with care Jan-Peter Heida (for Gupta Strategists)	Quality is discussed more in the B segment than in the A segment. Insurers and hospitals are not yet on the same wavelength. Background study for the Council for Public Health and Care.
Care balance sheet 2008. Performance in Dutch healthcare Xander Koolman (voor RIVM)	Healthcare performance was mapped based on over a hundred indicators. The second Care Balance Sheet broadly concludes: care is accessible, cost increases are moderate, but quality could be better.
The reliability and validity of the CQ-Index Piet Stam	Psychometric properties have been tested and agreed in two scientific studies of the CQ-Index for hospitals and the CQ-Index for Care and Health Insurance as initially introduced in the Netherlands at the time.
There are better policy instruments than a fixed book retail price Marja Appelman	The fixed retail book price does not seem to constitute the most effective policy measure in order to achieve pluralism and broad accessibility of books.