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Background: Recent attempts of active disinvestment (i.e. withdrawal of reimbursement by means of a policy decision) of reimbursed healthcare interventions in the Netherlands have differed in their outcome: some attempts were successful, with interventions actually being disinvested. Other attempts were terminated at some point, implying unsuccessful disinvestment. This study aimed to obtain insight into recent active disinvestment processes, and to explore what aspects affect their outcome.Methods: Semi-structured interviews were conducted from January to December 2018 with stakeholders (e.g. patients, policymakers, physicians) who were involved in the policy process of five cases for which the full or partial withdrawal of reimbursement was considered in the Netherlands between 2007 and 2017: benzodiazepines, medication for Fabry disease, quit smoking programme, psychoanalytic therapy and maternity care assistance. These cases covered both interventions that were eventually disinvested and interventions for which reimbursement was maintained after consideration. Interviews were transcribed verbatim, double coded and analyzed using thematic analysis.Results: The 37 interviews showed that support for disinvestment from stakeholders, especially from healthcare providers and policymakers, strongly affected the outcome of the disinvestment process. Furthermore, the institutional role of stakeholders as legitimized by the Dutch health insurance system, their financial interests in maintaining or discontinuing reimbursement, and the possibility to relieve the consequences of disinvestment for current patients affected the outcome of the disinvestment process as well. A poor organization of patient groups may make it difficult for patients to exert pressure, which may contribute to successful disinvestment. No evidence was found of a consistent role of the formal Dutch package criteria (i.e. effectiveness, cost-effectiveness, necessity and feasibility) in active disinvestment processes.Conclusions: Contextual factors as well as the possibility to relieve the consequences of disinvestment for current patients are important determinants of the outcome of active disinvestment processes. These results provide insight into active disinvestment processes and their determinants, and provide guidance to policymakers for a potentially more successful approach for future active disinvestment processes. [ABSTRACT FROM AUTHOR]

Objective: The objective of this systematic review was to review the available evidence on the disparity between willingness to accept (WTA) and willingness to pay (WTP) for healthcare goods and services.Methods: A tiered approach consisting of (1) a systematic review, (2) an aggregate data meta-analysis, and (3) an individual participant data meta-analysis was used. MEDLINE, EMBASE, Scopus, Scisearch, and Econlit were searched for articles reporting both WTA and WTP for healthcare goods and services. Individual participant data were requested from the authors of the included studies.Results: Thirteen papers, reporting WTA and WTP from 19 experiments/subgroups, were included in the review. The WTA/WTP ratios reported in these papers, varied from 0.60 to 4.01, with means of 1.73 (median 1.31) for 15 estimates of the mean and 1.58 (median 1.00) for nine estimates of the median. Individual data obtained from six papers, covering 71.2% of the subjects included in the review, yielded an unadjusted WTA/WTP ratio of 1.86 (95% confidence interval 1.52-2.28) and a WTA/WTP ratio adjusted for age, sex, and income of 1.70 (95% confidence interval 1.42-2.02). Income category and age had a statistically significant effect on the WTA/WTP ratio. The approach to handling zero WTA and WTP values has a considerable impact on the WTA/WTP ratio found.Conclusions and Implications: The results of this study imply that losses in healthcare goods and services are valued differently from gains (ratio > 1), but that the degree of disparity found depends on the method used to obtain the WTA/WTP ratio, including the approach to zero responses. Irrespective of the method used, the ratios found in our meta-analysis are smaller than the ratios found in previous meta-analyses. [ABSTRACT FROM AUTHOR]

Objective This study aimed to identify characteristics that affect parental decisions about rotavirus vaccination, to determine the relative importance of those characteristics and subsequently to estimate vaccination coverage for different implementation strategies. Methods A Discrete choice experiment (DCE) questionnaire was sent to the parents of 1250 newborns aged 6 weeks (response rate 37.3%). Mixed-logit models were used to estimate the relative importance of the five included rotavirus vaccine and implementation characteristics; vaccine effectiveness, frequency of severe side effects, protection duration, the healthcare facility that administrates vaccination and out-of-pocket costs. Based on the utility functions of the mixed-logit model, the potential vaccination coverage was estimated for different vaccine scenarios and implementation strategies. Results All characteristics, except for healthcare facility that administrates vaccination, influenced parental willingness to vaccinate their newborn against rotavirus. Parents were willing to trade 20.2 percentage points vaccine effectiveness for the lowest frequency of severe side effects (i.e., 1 in 1,000,000) or 20.8 percentage points for a higher protection duration. Potential vaccination coverage ranged between 22.7 and 86.2%, depending on vaccine scenario (i.e., vaccine effectiveness and protection duration) and implementation strategy (i.e., out-of-pocket costs and healthcare facility that administrates vaccination). Conclusions When deciding about vaccination against rotavirus, parents are mostly driven by the out-of-pocket costs, vaccine effectiveness, protection duration, and frequency of severe side effects. The highest vaccination coverage is expected for a vaccine with high effectiveness and protection duration that is implemented within the current National Immunization Program context. Implementation of the same rotavirus vaccine in the free market will result in lowest coverage. [ABSTRACT FROM AUTHOR]

Abstract: From October 2011, The Netherlands started to vaccinate all newborns against hepatitis B. The aim of the present study was to get insight in the psychosocial factors that determine parents’ intention to vaccinate their child against hepatitis B, and to test whether intention to vaccinate is a good predictor of actual vaccination behaviour. In total, 2000 parents of newborns (0–2 weeks old) received a self-report questionnaire measuring intention towards hepatitis B vaccination and its psychosocial determinants (response rate 45.6%). Participants were invited for follow-up research and subsequently offered the opportunity to have their child vaccinated against hepatitis B. The findings showed that the large majority of parents intend to vaccinate their child against hepatitis B. The intention to vaccinate was most strongly determined by parents’ attitude towards hepatitis B vaccination, which in turn was positively associated with perceived benefits of the vaccination and perceptions of the child''s susceptibility to hepatitis B. The majority of the 246 parents that accepted the invitation for a follow-up study had their child vaccinated (83.7%). Intention was found to be a significant predictor of vaccination behaviour although less strong than expected. It is concluded that Dutch parents were positive towards hepatitis B vaccination in terms of both intention and behaviour. To further sustain parents’ positive attitudes towards hepatitis B vaccination, educational campaigns should strengthen the benefits of vaccination along with emphasizing the child''s risk to hepatitis B infection. [Copyright &y& Elsevier]

Background: The oral anticoagulant therapy - provided to prevent thrombosis - is known to be associated with substantial avoidable hospitalization. Improving the quality of the oral anticoagulant therapy could avoid drug related hospitalizations. Therefore, this study compared the patient outcomes between Dutch anticoagulant clinic (AC) regions taking the variation in chronic care management into account in order to explore whether chronic care management elements could improve the quality of oral anticoagulant therapy. Methods: Two data sources were combined. The first source was a questionnaire that was send to all ACs in the Netherlands in 2008 (response = 100%) to identify the application of chronic care management elements in the AC regions. The Chronic Care Model of Wagner was used to make the concept of chronic care management operational. The second source was the report of the Dutch National Network of ACs which contains patient outcomes of the ACs. Results: Patient outcomes achieved by the ACs were good, yet differences existed; for instance the percentage of patients in the appropriate therapeutic ranges varied from 67 to 87% between AC regions. Moreover, differences existed in the use of chronic care management elements of the chronic care model, for example 12% of the ACs had multidisciplinary meetings and 58% of the ACs had formal agreements with at least one hospital within their region. Patient outcomes were significantly associated with patient orientation and the number of specialized nurses versus doctors (p-values < 0.05). Furthermore, the overall extent to which chronic care management elements were applied was positively associated with patient outcomes (p-values < 0.05). Conclusions: Substantial differences in the patient outcomes as well as chronic care management of oral anticoagulant therapy existed. Since our results showed a positive association between overall application of chronic care management and patient outcomes, additional research is needed to fully understand the working mechanism of chronic care management. [ABSTRACT FROM AUTHOR]

Active disinvestment of healthcare interventions (i.e. discontinuing reimbursement by means of a policy decision) has received limited public support in the past. Previous research has identified four viewpoints on active disinvestment among citizens in the Netherlands. However, it remained unclear how strong these viewpoints are supported by society, and by whom. Therefore, the current study aimed to 1) measure the support for these four viewpoints and 2) assess whether support is associated with background characteristics of citizens. In an online survey, a representative sample of adult citizens in the Netherlands (n = 1794) was asked to rate their agreement with short narratives of the four viewpoints on a 7-point Likert scale. The survey also included questions on sociodemographic characteristics, health status, healthcare utilization, and opinions about responsibility and costs in the healthcare context. Logistic regression models were estimated for each viewpoint to assess the association between viewpoint support and these characteristics. The support for the different viewpoints varied between 46.8% and 57.7% of the sample. Viewpoint support was associated with participants' age, gender, educational level, financial situation, healthcare utilization, opinion on the responsibility of the government for the health of citizens, and opinion on whether the increase in healthcare expenditure and health insurance premiums is considered a problem. Resistance to active disinvestment may partially be explained by the consequences of disinvestment citizens anticipate experiencing themselves. Citizens considering the increase in healthcare expenditure a larger problem were more supportive of disinvestment than those considering it less of a problem. • Four distinct viewpoints on disinvestment were supported by half of Dutch citizens. • Concerns on negative consequences of disinvestment are associated with resistance. • Concerns on rising healthcare costs are associated with support for disinvestment. [ABSTRACT FROM AUTHOR]