Verschillen zorgkosten tussen zorggroepen? Vergelijking van zorggroepen voor mensen met diabetes

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:
Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance?
Design:
Cross-sectional, multi-level study.
Method:
The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves.
Results:
The mean costs of the total curative care per patient were €3,092 - €6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (€2,884 - €3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7% vs. 0.4%).
Conclusion:
The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.
Original languageDutch
Article numberD701
JournalNederlandsch Tijdschrift voor Geneeskunde
Volume2017
Issue number161
Publication statusPublished - 2017

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). Verschillen zorgkosten tussen zorggroepen? Vergelijking van zorggroepen voor mensen met diabetes. Nederlandsch Tijdschrift voor Geneeskunde, 2017(161), [D701].
Mohnen, S.M. ; Molema, C.C.M. ; Steenbeek, W. ; van den Berg, M.J. ; de Bruin, S.R. ; Baan, C.A. ; Struijs, J.N. / Verschillen zorgkosten tussen zorggroepen? Vergelijking van zorggroepen voor mensen met diabetes. In: Nederlandsch Tijdschrift voor Geneeskunde. 2017 ; Vol. 2017, No. 161.
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title = "Verschillen zorgkosten tussen zorggroepen?: Vergelijking van zorggroepen voor mensen met diabetes",
abstract = "Objective:Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance?Design:Cross-sectional, multi-level study.Method:The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves.Results:The mean costs of the total curative care per patient were €3,092 - €6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (€2,884 - €3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7{\%} vs. 0.4{\%}).Conclusion:The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.",
author = "S.M. Mohnen and C.C.M. Molema and W. Steenbeek and {van den Berg}, M.J. and {de Bruin}, S.R. and C.A. Baan and J.N. Struijs",
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Mohnen, SM, Molema, CCM, Steenbeek, W, van den Berg, MJ, de Bruin, SR, Baan, CA & Struijs, JN 2017, 'Verschillen zorgkosten tussen zorggroepen? Vergelijking van zorggroepen voor mensen met diabetes' Nederlandsch Tijdschrift voor Geneeskunde, vol. 2017, no. 161, D701.

Verschillen zorgkosten tussen zorggroepen? Vergelijking van zorggroepen voor mensen met diabetes. / 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: Nederlandsch Tijdschrift voor Geneeskunde, Vol. 2017, No. 161, D701, 2017.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Verschillen zorgkosten tussen zorggroepen?

T2 - Vergelijking van zorggroepen voor mensen met diabetes

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

Y1 - 2017

N2 - Objective:Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance?Design:Cross-sectional, multi-level study.Method:The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves.Results:The mean costs of the total curative care per patient were €3,092 - €6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (€2,884 - €3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7% vs. 0.4%).Conclusion:The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.

AB - Objective:Is the simple mean of the costs per diabetes patient a suitable tool with which to compare care groups? Do the total costs of care per diabetes patient really give the best insight into care group performance?Design:Cross-sectional, multi-level study.Method:The 2009 insurance claims of 104,544 diabetes patients managed by care groups in the Netherlands were analysed. The data were obtained from Vektis care information centre. For each care group we determined the mean costs per patient of all the curative care and diabetes-specific hospital care using the simple mean method, then repeated it using the 'generalized linear mixed model'. We also calculated for which proportion the differences found could be attributed to the care groups themselves.Results:The mean costs of the total curative care per patient were €3,092 - €6,546; there were no significant differences between care groups. The mixed model method resulted in less variation (€2,884 - €3,511), and there were a few significant differences. We found a similar result for diabetes-specific hospital care and the ranking position of the care groups proved to be dependent on the method used. The care group effect was limited, although it was greater in the diabetes-specific hospital costs than in the total costs of curative care (6.7% vs. 0.4%).Conclusion:The method used to benchmark care groups carries considerable weight. Simply stated, determining the mean costs of care (still often done) leads to an overestimation of the differences between care groups. The generalized linear mixed model is more accurate and yields better comparisons. However, the fact remains that 'total costs of care' is a faulty indicator since care groups have little impact on them. A more informative indicator is 'costs of diabetes-specific hospital care' as these costs are more influenced by care groups.

UR - https://www.ntvg.nl/artikelen/verschillen-zorgkosten-tussen-zorggroepen

M3 - Article

VL - 2017

JO - Nederlandsch Tijdschrift voor Geneeskunde

JF - Nederlandsch Tijdschrift voor Geneeskunde

SN - 0028-2162

IS - 161

M1 - D701

ER -