Seminar: Unintended effects of reimbursement schedules in mental health care

Time: 13.00-14.00 hours
Location: CPB-office, Van Stolkweg 14, The Hague

Presentation: Rudy Douven (CPB)

Discussant: Bastian Ravesteijn (EUR)

Language: English

Registration: Please register by sending an email to seminars@cpb.nl.

Abstract subject
We study the effect of the introduction of a reimbursement schedule for self-employed mental health care providers in the Netherlands in 2008. In this schedule treatment duration mainly determines the fee for the provider. Treatment duration follows a discontinuous discrete step function: the provider receives a higher fee for a longer treatment duration, but once he has passed a threshold, he receives no additional fees for treating a patient a bit longer.  As a consequence, the provider will only treat his patient longer if marginal benefits outweigh marginal cost (an efficiency effect). We use administrative mental health care data of the total Dutch population from 2008-2010. We find that this the new reimbursement schedule leads to 2-6% lower treatment durations and 3-5% lower costs compared to a control group. However, we also find evidence for an opposite effect: providers treat patients longer to reach a next threshold and obtain a higher fee. Our findings show gaps (bunches) in the distribution function of treatment durations, just before (after) hitting a treatment duration threshold. We estimate that these effects prolong treatment duration by 11-13%. This translates into an overall increase of mental health care costs of approximately 7-8%.

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