University of Twente Student Theses


Determining factors that influence purchasing laboratory services in primary care

Bentum, S.B. (2018) Determining factors that influence purchasing laboratory services in primary care.

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Abstract:BACKGROUND In 2006 the Health Insurance Act (in Dutch: ‘Zorgverzekeringswet’) was implemented by the Dutch government, which reformed the health care system and made basic health insurance mandatory. The health care insurer contracts diagnostics providers to perform diagnostics. Laboratory diagnostics support physicians, both in primary and secondary care, in medical decision making. Laboratory testing may be applied in the entire chain of care and is often essential for prognosis, diagnosis or monitoring of treatment effects. As purchasers of health care services, health insurance companies have a limited influence on shifting of volume, since the GP is the referrer and has a relationship with various suppliers of diagnostics. Blood collection is not centrally organized, because a majority of the providers of diagnostics takes care of its own blood collection. Based on this, the assumption is made by Menzis (a health insurance company in the Netherlands) that a central organisation of blood collection might lead to economies of scale in terms of quality and costs. Menzis wants to find out if it is possible to implement a new purchasing strategy that improves the organisation of laboratory diagnostics, in primary care, together with the players in the field. This with the aim of continuation or even better quality of care, sufficient locations for phlebotomy, a reduction of costs for the premium payers and possibly as a consequence, a reduced number of diagnostic providers. METHOD To answer the stated research question, with corresponding sub-questions, a design of qualitative explorative research was chosen. First, an analysis of the current situation and organisation of laboratory services was performed. Second, a literature search was conducted to collect empirical data on contracting and identify purchasing strategy options, suitable for the case of laboratory services. This study is carried out at request of Menzis, which expressed the need of stakeholders input. RESULTS The literature review identified thirteen considerations for defining a purchasing strategy for laboratory services. These alternatives are divided into three categories, corresponding the first three steps of the purchasing process, namely specification, selection and contracting. Subsequently the considerations are complemented with the results of the semi-structured interviews. CONCLUSION This study shows that there is a possibility to make adjustments in a purchasing strategy, with the use of the previous mentioned thirteen considerations. Subsequently, with implementing any kind of change in the purchasing strategy of primary care diagnostics, the regional differences need to be taken into account. This due to the variation of practice and the complexity of the organisation of primary care, which results in interdependency between considerations. As a result, three scenarios are drafted based on the considerations and difficulties experienced by stakeholders.
Item Type:Essay (Master)
Unknown organization, Enschede
Faculty:TNW: Science and Technology
Subject:01 general works, 85 business administration, organizational science
Programme:Health Sciences MSc (66851)
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