Cost variation in diabetes care across Dutch care groups?

S.M. Mohnen, C.C.M. Molema, W. Steenbeek, M.J. Van Den Berg, S.R. De Bruin, C.A. Baan, J.N. Struijs

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Objective
The introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.
Data Source
Dutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).
Study Design
Both a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.
Principal Findings
Care groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups’ rank positions differed, with consequences on the top-10 and the low-10 positions.
Conclusions
Differences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups.
Original languageEnglish
Pages (from-to)93-112
JournalHealth Services Research
Volume52
Issue number1
DOIs
Publication statusPublished - Feb 2017

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Benchmarking
Linear Models
Netherlands
Type 2 Diabetes Mellitus

Cite this

Mohnen, S. M., Molema, C. C. M., Steenbeek, W., Van Den Berg, M. J., De Bruin, S. R., Baan, C. A., & Struijs, J. N. (2017). Cost variation in diabetes care across Dutch care groups? Health Services Research, 52(1), 93-112. https://doi.org/10.1111/1475-6773.12483
Mohnen, S.M. ; Molema, C.C.M. ; Steenbeek, W. ; Van Den Berg, M.J. ; De Bruin, S.R. ; Baan, C.A. ; Struijs, J.N. / Cost variation in diabetes care across Dutch care groups?. In: Health Services Research. 2017 ; Vol. 52, No. 1. pp. 93-112.
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title = "Cost variation in diabetes care across Dutch care groups?",
abstract = "ObjectiveThe introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.Data SourceDutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).Study DesignBoth a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.Principal FindingsCare groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups’ rank positions differed, with consequences on the top-10 and the low-10 positions.ConclusionsDifferences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups.",
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Mohnen, SM, Molema, CCM, Steenbeek, W, Van Den Berg, MJ, De Bruin, SR, Baan, CA & Struijs, JN 2017, 'Cost variation in diabetes care across Dutch care groups?', Health Services Research, vol. 52, no. 1, pp. 93-112. https://doi.org/10.1111/1475-6773.12483

Cost variation in diabetes care across Dutch care groups? / Mohnen, S.M.; Molema, C.C.M.; Steenbeek, W.; Van Den Berg, M.J.; De Bruin, S.R.; Baan, C.A.; Struijs, J.N.

In: Health Services Research, Vol. 52, No. 1, 02.2017, p. 93-112.

Research output: Contribution to journalArticleScientificpeer-review

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T1 - Cost variation in diabetes care across Dutch care groups?

AU - Mohnen, S.M.

AU - Molema, C.C.M.

AU - Steenbeek, W.

AU - Van Den Berg, M.J.

AU - De Bruin, S.R.

AU - Baan, C.A.

AU - Struijs, J.N.

PY - 2017/2

Y1 - 2017/2

N2 - ObjectiveThe introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.Data SourceDutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).Study DesignBoth a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.Principal FindingsCare groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups’ rank positions differed, with consequences on the top-10 and the low-10 positions.ConclusionsDifferences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups.

AB - ObjectiveThe introduction of bundled payment for diabetes care in the Netherlands led to the origination of care groups. This study explored to what extent variation in health care costs per patient can be attributed to the performance of care groups. Furthermore, the commonly applied simple mean aggregation was compared with the more advanced generalized linear mixed model (GLMM) to benchmark health care costs per patient between care groups.Data SourceDutch 2009 nationwide insurance claims data of diabetes type 2 patients (104,544 patients, 50 care groups).Study DesignBoth a simple mean aggregation and a GLMM approach was applied to rank care groups, using two different health care costs variables: total treatment health care costs and diabetes-specific specialist care costs per diabetes patient.Principal FindingsCare groups varied slightly in the first and mainly in the second indicator. Care group variation was not explained by composition. Although the ranking methods were correlated, some care groups’ rank positions differed, with consequences on the top-10 and the low-10 positions.ConclusionsDifferences between care groups exist when an appropriate indicator and a sophisticated aggregation technique is used. Currently applied benchmarking may have unfair consequences for some care groups.

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Mohnen SM, Molema CCM, Steenbeek W, Van Den Berg MJ, De Bruin SR, Baan CA et al. Cost variation in diabetes care across Dutch care groups? Health Services Research. 2017 Feb;52(1):93-112. https://doi.org/10.1111/1475-6773.12483