VARIABLES INFLUENCING COMPETITION IN DUTCH MEDICAL SPECIALIST CARE
Author(s)
Jeroen Mulder, EMFC, MsC1, M. Cloodt, PhD2, C. Boersma, PhD2.
1Open Universiteit / Pollinator Group, Heerlen, Netherlands, 2Open Universiteit, Heerlen, Netherlands.
1Open Universiteit / Pollinator Group, Heerlen, Netherlands, 2Open Universiteit, Heerlen, Netherlands.
OBJECTIVES: Regulated competition has been a cornerstone of the Dutch healthcare system since 2006 and underwent significant reform in 2015. However, evidence on the factors influencing competition in medical specialist care remains fragmented. The aim of this study was to identify and synthesize variables influencing competition in Dutch medical specialist care including the examination of potential interactions from a health systems perspective.
METHODS: A systematic literature review was conducted following PRISMA guidelines. Peer-reviewed studies published from 2015 onwards were identified through structured database searches and screened against predefined eligibility criteria. Data were analyzed using a hybrid deductive-inductive coding approach. Guided by systems theory, variables were categorized into the general- or task environment and subsequently clustered according to PESTEL and Porter’s Five Forces frameworks.
RESULTS: Fifty-eight studies met the inclusion criteria. The review identified 224 variables, grouped into 40 subcategories across the general- and task environment. Most variables were found within the legal domain (n=50). Recurring themes included regulatory frameworks, healthcare governance, information availability, stakeholder behavior, market organization, and technological developments. While individual studies often examined isolated determinants, synthesis revealed that competition is shaped by dynamic interactions among policy, market, and organizational factors, characterized by feedback mechanisms and interdependencies.
CONCLUSIONS: Competition in Dutch medical specialist care is best understood as an adaptive system rather than a collection of isolated market determinants. The findings suggest that systems-oriented policy approaches are needed to account for interactions and unintended effects across domains. Short term improvements for competition are sunlight remedies, including improved disclosure of quality and performance information. This may strengthen accountability and reduce information asymmetries. Furthermore, competition may contribute to increased value generation through innovation, specialization, intellectual property development, and international competitiveness, creating positive feedback effects that support healthcare quality while generating additional resources to support long-term healthcare sustainability
METHODS: A systematic literature review was conducted following PRISMA guidelines. Peer-reviewed studies published from 2015 onwards were identified through structured database searches and screened against predefined eligibility criteria. Data were analyzed using a hybrid deductive-inductive coding approach. Guided by systems theory, variables were categorized into the general- or task environment and subsequently clustered according to PESTEL and Porter’s Five Forces frameworks.
RESULTS: Fifty-eight studies met the inclusion criteria. The review identified 224 variables, grouped into 40 subcategories across the general- and task environment. Most variables were found within the legal domain (n=50). Recurring themes included regulatory frameworks, healthcare governance, information availability, stakeholder behavior, market organization, and technological developments. While individual studies often examined isolated determinants, synthesis revealed that competition is shaped by dynamic interactions among policy, market, and organizational factors, characterized by feedback mechanisms and interdependencies.
CONCLUSIONS: Competition in Dutch medical specialist care is best understood as an adaptive system rather than a collection of isolated market determinants. The findings suggest that systems-oriented policy approaches are needed to account for interactions and unintended effects across domains. Short term improvements for competition are sunlight remedies, including improved disclosure of quality and performance information. This may strengthen accountability and reduce information asymmetries. Furthermore, competition may contribute to increased value generation through innovation, specialization, intellectual property development, and international competitiveness, creating positive feedback effects that support healthcare quality while generating additional resources to support long-term healthcare sustainability
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR204
Topic
Economic Evaluation, Health Policy & Regulatory
Topic Subcategory
Insurance Systems & National Health Care, Public Spending & National Health Expenditures, Reimbursement & Access Policy
Disease
No Additional Disease & Conditions/Specialized Treatment Areas