Towards population-based payment models in a multiple-payer system: the case of the Netherlands

The Dutch private multi-payer system is characterised by a catalogue that is dominated by fee-for-service based payments. Up to now, alternative payment models have not taken flight. Recent small-scale experiments show substantial potential benefits of population-based payment models. Drawing on international literature and two expert focus groups, we analyse how population-based payments may be taken up more fiercely in a system run on the principles of managed competition.The decentralised nature of the Dutch system naturally aligns with a bottom-up implementation approach. Payers and providers can initiate population-based payment systems to fit local needs, but should determine clear preconditions that focus on quality of care. Quality indicators tied to financial incentives, such as shared savings, might minimise risks of undertreatment. Deliberative processes between payer and providers may determine adequate indicators. Upfront investments are needed to facilitate necessary data infrastructure. Furthermore, alternative payment systems might be encouraged through nationally set default options towards integrated payment systems, potentially reducing administrative burdens. Strong leadership, trust, and mutual understanding are paramount to overcome silos to integrate services across providers. Policymakers in other multi-payer managed competition systems may benefit from these insights.