Identifying and explaining the variability in development and implementation costs of disease management programs in the Netherlands

BMC Health Services Research

Maureen PMM Rutten-van Mölken¹  Roland Bal¹  Samantha A Adams¹  Bethany Hipple Waters²  Apostolos Tsiachristas¹ 

[1] Department of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, 3000, DR, The Netherlands;Center for Child and Adolescent Health Policy, Massachusetts General Hospital, Boston, Massachusetts, USA

关键词: ICT;    The Netherlands;    Costs;    Integrated care;    Disease management;    COPD;    Cardiovascular risk;    Chronic disease;   

Others  :  1118210
DOI  :  10.1186/s12913-014-0518-0

 received in 2014-02-18, accepted in 2014-10-13,  发布年份 2014

【 摘 要 】

Background

In the Netherlands, disease management programs (DMPs) are used to treat chronic diseases. Their aim is to improve care and to control the rising expenditures related to chronic diseases. A bundled payment was introduced to facilitate the implementation of DMPs. This payment is an all-inclusive price per patient per year for a pre-specified care package. However, it is unclear to which extent the costs of developing and implementing DMPs are included in this price. Consequently, the organizations providing DMPs bear financial risk because the development and implementation (D&I) costs may be substantial. The aim of this paper is to investigate the variability in and drivers of D&I costs among 22 DMPs and highlight characteristics that impactthese.

Methods

The data was analyzed using a mixed methods approach. Descriptive statistical analysis explored the variability in D&I costs as measured by a self-developed costing instrument and investigated the drivers. In addition, qualitative research, including document analysis andinterviews, was conducted to explain the possible underlying reasons of cost variability.

Results

The development costs varied from €5,891 to €274,783 and the implementation costs varied from €7,278 to €387,879 across DMPs. Personnel costs were the main component of development. Development costs were strongly correlated with the implementation costs (ρ = 0.55), development duration (ρ = 0.74), and number of FTEs dedicated DMP development. Organizations with large size and high level of care prior to the implementation of a DMP had relatively low development costs. These findings were in line with the cross-case qualitative comparison where programs with a longer history, more experienced project leadership, previously established ICT systems, and less complex patient populations had lower D&I costs.

Conclusions

There is wide variation in D&I costs of DMPs, which is driven primarily by the duration of the development phase and the staff needed to develop and implement a DMP. These drivers are influenced by the attributes of the DMP, characteristics of the target population, project leadership, and ICT involved. There are indications of economies of scale and economies of scope, which may reduce D&I costs.

【 授权许可】

   
2014 Tsiachristas et al.; licensee BioMed Central Ltd.

【 图 表 】

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