Patrick Paulus Theodoor Jeurissen

• Ph.D Health, Economics, Policy and Law
• Professor (Full) at Radboud University Medical Centre (Radboudumc)

The market-oriented reform in the Dutch health care system is now in its 10th year. This article offers a concise overview of some of its effects thus far on health insurance, healthcare purchasing and healthcare provision. Furthermore, attention is given to its impact on healthcare expenditures, power and trust relationships as well as the relatio...

A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, E...

Importance A higher out-of-pocket price for mental health care may lead not only to cost savings but also to negative downstream consequences. Objective To examine the association of higher patient cost sharing with mental health care use and downstream effects, such as involuntary commitment and acute mental health care use. Design, Setting, and...

Background: Publicly funded healthcare forms an intricate part of government spending in most Organisation for Economic Co-operation and Development (OECD) countries, because of its reliance on entitlements and dedicated revenue streams. The impact of budgetary rules and procedures on publicly funded health care might thus be different from other...

Background and Aims Expected utility is deeply ingrained in the field of health economic evaluation, but critics highlight its theoretical flaws, including assumptions of complete information, bounded rationality, and stable preferences. They propose incorporating experienced utility for greater accuracy and suggest certain measurement methods. How...

Introduction: The standard approach to predicting health behaviour in health economics depends on the deployment of expected utility as a predictor. However, this standard approach only explains limited variance in health behaviour, prompting the proposition of the substitutive and complementary approaches. Until now, both approaches have not yet b...

The Oxford Handbook of Dutch Politics presents a comprehensive longitudinal overview of the Dutch political system. It outlines the Dutch political system’s origins, historical development, key institutions, faults, processes, and key public policy dynamics. Old social cleavages of Dutch politics waned following the influence of long-term demograph...

Rationale Healthcare systems remain disease oriented despite growing sustainability concerns caused by inadequate management of patients with multimorbidity. Comprehensive care programmes (CCPs) can play an important role in streamlining care delivery, but large differences in setup and results hinder firm conclusions on their effectiveness. Many e...

Background The Netherlands faces 60% prevalence of chronic conditions by 2040, impacting societal participation and quality of life. Current clinical care inadequately addresses these consequences, and most hospitals do not integrate occupational health in their care. Objectives To develop a generic person- and work-oriented medical care model (WM...

Academic Medical Centres (AMCs) are large organisations with a complex structure due to various intertwined missions and (public) roles that can be conflicting. This complexity makes it difficult to adapt to changing circumstances. The literature points to the use of business models to address such challenges. A business model describes the resourc...

Background: An innovative, integrative care model for people with Parkinson (PRIME Parkinson) has gradually been implemented in a selected region of the Netherlands since 2021. A prospective evaluation of this model (PRIME-NL study) was initiated in parallel, spanning the year prior to implementation (baseline) and the implementation period. Follow...

To develop and internally validate prediction models with machine learning for future potentially preventable healthcare utilization in patients with multiple long term conditions (MLTC). This study is the first step in investigating whether prediction models can help identify patients with MLTC that are most in need of integrated care. A retrospec...

This article discusses the results and prospects of the market reform in Dutch health care which came into force in 2006. Attention is paid to the results of the health insurance reform, the experience with the shift from passive to active purchasing and the impact of the reform on healthcare provision and cost control respectively. Other topics di...

Introduction Academic medical centres (AMCs) are designed to perform multiple tasks within a single organisation. This institutional complexity gives rise to intricate governance challenges and promotes incrementalism and muddling. Method In this study, we hypothesised that radical change could provide a solution to the current incrementalism and...

Background: People with dementia are increasingly living at home, relying on primary care providers for most healthcare needs. Suboptimal collaboration and communication between providers could cause inefficiencies and worse patient outcomes. Innovative strategies are needed to address this growing disease burden and rising healthcare costs. The De...

Background Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown...

Background Affordability and accessibility of hospital care are under pressure. Research on hospital care financing focuses primarily on incentives in the financial system outside the hospital. It is notable that little is known about (incentives in) internal funding in hospitals. Therefore, our study focuses on the budget allocation in hospitals:...

The Dutch health system is financed predominantly by commercial bank loans, especially after the market-oriented reform in 2006, when government investment guarantees were abandoned. Commercial capital markets were envisaged to improve efficient capital allocation and management. We analyzed the effects of commercial bank loans on interest rates, i...

Background Hospital care organization, structured around medical specialties and focused on the separate treatment of individual organ systems, is challenged by the increasing prevalence of multimorbidity. To support the hospitals’ realization of multidisciplinary care, we hypothesized that using machine learning on clinical data helps to identify...

Background: Purchasing systems aim to improve resource allocation in healthcare markets. The Netherlands is characterized by four different purchasing systems: managed competition in the hospital market, a non-competitive single payer system for long-term care, municipal procurement for home care and social services, and self-procurement via person...

Introduction: As a result of an increasing focus on patient-centered care within oncology and more pressure on the sustainability of healthcare systems, the discussion on what exactly constitutes value re-appears. Policymakers seek to improve patient values, however funding all values is not sustainable. Areas covered: We collect available evide...

Objective: Noninvasive telemonitoring aims to improve healthcare for patients with chronic heart failure (HF) by reducing hospitalizations and improving patient experiences. Yet, sustainable adoption seems to be limited. Therefore, the goal of our study is to gain insight in the processes that support sustainable adoption of telemonitoring for pat...

The notion of utility gained a strong foothold in health economics over the last decades. However, the concept of health utility has not yet been decisively or irrefutably defined and the definitions that exist often do not take into account the current state of psychological literature. This perspective paper shows that the current definition of h...

Background Many countries are looking for ways to increase nurse practitioner (NP) and physician assistant/associate (PA) deployment. Countries are seeking to tackle the pressing issues of increasing healthcare demand, healthcare costs, and medical doctor shortages. This article provides insights into the potential impact of various policy measures...

Background: Hospital strategies aimed at increasing quality of care and simultaneously reducing costs show potential to improve healthcare, but knowledge on real-world effectiveness is limited. In 2014, two Dutch hospitals introduced such quality-driven strategies. Our aim was to evaluate contexts, mechanisms, and outcomes of both strategies using...

Academic Medical Centres (AMCs) are important organisations for shaping healthcare. The purpose of this scoping review is to understand the scope and type of evidence related to the organisation of European AMCs. We selected the study population intending to obtain a demographic cross-section of European countries: Czech Republic, Germany, Latvia,...

Aims The aim of this study was to develop insights into how and why Dutch government policies on deployment and training of nurse practitioners and physician assistants have effect and under what circumstances. Design A realist analysis using qualitative interviews. Methods Data analysis of 50 semi‐structured interviews conducted in 2019 with hea...

Comorbidities can have major implications for cancer care, as they might impact the timing of cancer diagnosis, compromise optimal care, affect treatment outcomes, and increase healthcare costs. Thus, it is important to comprehensively evaluate cancer comorbidities and examine trends over time. Here, we performed a systematic literature review on t...

Background Chronic heart failure (CHF) poses a major challenge for healthcare systems. As these patients’ needs vary over time in intensity and complexity, the coordination of care between primary and secondary care is critical for them to receive the right care in the right place. To support the continuum of care needed, Dutch regional transmural...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

This volume examines the public/private sector mix in a number of national healthcare systems and their interface with the goals of health equity and quality of healthcare. Moreover, there is a consideration of public accountability. The unique significance of this collection of national studies involving the public/private sector mix of healthcare...

Background: Cancer rates and expenditures are increasing, resulting in debates on the exact value of this care. Perspectives on what exactly constitutes worthwhile values differ. This study aims to explore all values-elements regarding new oncological treatments for patients with cancer and all stakeholders involved and to assess their implication...

Objective: We aimed to increase the understanding of the scaling of de-implementation strategies by identifying the determinants of the process and developing a determinant framework. Design and methods: This study has a mixed-methods design. First, we performed an integrative review to build a literature-based framework describing the determina...

Study design: An in-depth interview study including patients, general practitioners, neurologists and neurosurgeons. Objective: To gain insight in decision-making in sciatica care, by identifying patients' and physicians' preferences for treatment options, and the differences between and within both groups. Summary of background data: Sciatica...

BACKGROUND Chronic heart failure (HF) is a chronic disease affecting more than 64 million people worldwide, with an increasing prevalence and a high burden on individual patients and society. Telemonitoring may be able to mitigate some of this burden by increasing self-management and preventing use of the health care system. However, it is unknown...

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,...

Health systems invest in coordination and collaboration between emergency departments (ED) and after-hours primary care providers (AHPCs) to alleviate pressure on the acute care chain. There are substantial gaps in the existing evidence, limited in sample size, follow-up care, and costs. We assess whether acute care collaborations (ACCs) are associ...

Les performances du système de santé des Pays-Bas ont été attribuées à l’introduction de la concurrence régulée comme principe directeur des soins médicaux dans la loi sur l’assurance maladie en 2006. La croissance lente des coûts pendant une décennie peut être considérée comme un accomplissement majeur. Toutefois, dans la pratique quotidienne de c...

Het kabinet-Rutte IV wil de regeldruk voor zorgprofessionals aanpakken. Tegelijkertijd staat er beleid in de steigers, zoals passende zorg, dat gemakkelijk tot hogere administratieve kosten kan leiden. Het is de vraag in hoeverre de baten van het zorgbeleid opwegen tegen de extra administratieve kosten ervan. IN HET KORT ● Administratieve kosten i...

The Rutte IV administration can and will spend much less on healthcare than its predecessor. A difficult task. Providing less low-value care, that is healthcare with no or little benefit for the patient given the alternatives, by physicians is one way to improve quality and reduce costs. Less low-value care will therefore play a crucial role in the...

We provide an explorative and international comparison of the governance models of academic medical centres (AMCs). These centres face significant challenges, including disruptive external pressures and enduring financial conflicts pertaining to patient treatment, research and education. Therefore, we covered 10 European countries (Cyprus, Czechia,...

Inadequate treatment of multimorbidity is recognised as a major determinant of the effectiveness of healthcare and also of its inappropriate expenditures. However, current payment systems target, primarily, the treatment of single diseases, thus hindering integrated delivery of care for patients with multimorbidity (PwM). This review aims to assess...

Het Kabinet heeft grote ambities op het vlak van betaalbare zorg en sociaaleconomische gezondheidsverschillen. Daarvoor kiest het niet voor een stelselwijziging in de zorg, maar voor meer sturing op doelmatigheid om de budgettaire opgave te realiseren. Dit staat in contrast met voorgaande jaren en ook met de uitgangspunten van het curatieve zorgste...

The books Vijftig jaar kostenbeheersing in de zorg. Deel I: 1966-1995 en Deel II: 1995 are a twin-panel on cost control and cost control policy for healthcare.

Background: A lack of knowledge exists on real world hospital strategies that seek to improve quality, while reducing or containing costs. The aim of this study is to identify hospitals that have implemented such strategies and determine factors influencing the implementation. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library...

In 2006, The Netherlands embarked upon an ambitious reform of the Dutch health care system based upon the principles of regulated competition. Fiscal sustainability go the system has improved. In many places diversity has increased among providers, insurance policies etc. High levels of universal access are still paramount for the system. However,...

Background Academic Medical Centers (AMCs) are organizations that link three functions: providing highly specialized medical services, teaching activities and conducting research. The aim of the study was to provide an international comparison of the governance and organization models of AMCs. The analysis covered 10 European countries (Cyprus, Cze...

Context: Practitioners and politicians alike emphasise the wish to reduce administrative costs (AC) in Dutch LTC, but a robust empirical body of evidence on the components, determinants and value of AC in LTC is absent. Neither has the expert consensus of ways to track and trace AC in LTC been sought. Objective(s): We investigated whether it is pos...

Background Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the...

Introduction: Governments, purchasers and healthcare organizations see task reallocation as part of the solution for the increasing demand for care, increasing healthcare costs, and workforce shortages. Internationally, many governments are implementing policies regarding deployment of nurse practitioners (NPs) and physician assistants (PAs). Thus...

Context: Some nursing homes fared better than others to protect themselves against the 2019 coronavirus disease (COVID-19). Organisational characteristics may mediate the effect of the COVID-19 pandemic. Previous reviews have suggested for-profit providers provide worse quality of care. Does ownership also matter in the response to the COVID-19 pan...

Sugar consumption is on the rise globally with detrimental (oral) health effects. There is ample evidence that sugar-sweetened beverage (SSB) taxes can efficiently reduce sugar consumption. However, evidence alone is seldom enough to implement a policy. In this article, we present a narrative synthesis of evidence, based on real-world SSB tax evalu...

Sciatica is a common back problem with a generally positive natural course. This interview study was performed to gain increased insight into ambivalent and reluctant medicalization on the interactional level regarding the perceptions of Dutch patients and physicians about sciatica and its treatment options as a case study. While the concept of med...

The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning p...

Background: Optimal care for Parkinson's disease (PD) requires coordination and collaboration between providers within a complex care network. Individual patients have personalised networks of their own providers, creating a unique informal network of providers who treat ('share') the same patient. These 'patient-sharing networks' differ in densit...

s Developing and distributing a safe and effective SARS-CoV-2 (COVID-19) vaccine has garnered immense global interest. Less than a year after COVID-19 was declared a pandemic, several vaccine candidates had received emergency use authorization across a range of countries. Despite this scientific breakthrough, the journey from vaccine discovery to g...

BACKGROUND Chronic heart failure accounts for approximately 1%-2% of health care expenditures in most developed countries. These costs are primarily driven by hospitalizations and comorbidities. Telemonitoring has been proposed to reduce the number of hospitalizations and decrease the cost of treatment for patients with heart failure. However, the...

Background In the Netherlands, the for-profit sector has gained a substantial share of nursing home care within just a few years. The ethical question that arises from the growth of for-profit care is whether the market logic can be reconciled with the provision of healthcare. This question relates to the debate on the Moral Limits of Markets (MLM)...

For-profit hospitals’ market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historica...

Sweetened beverage (SB) taxes have recently been introduced to prevent obesity by several governments, but limited information on related policy adoption processes hampers further diffusion. We investigated the agenda-setting and decision-making phases of SB tax reforms in Berkeley and Philadelphia (where it was successfully adopted), and Cook Coun...

Begrotingsregels dempen collectieve zorguitgaven H et kabinet neemt in de coronacrisis verregaan-de maatregelen om zorgaanbieders financiële zekerheid te verschaffen. Budgettaire kaders worden feitelijk tijdelijk buiten spel gezet, ook in de zorg. Normaal zijn de Nederlandse zorguitgaven ech-ter strikt onderdeel van de begrotingsregels van het kabi...

The current coronavirus disease 2019 (COVID-19) pandemic is testing healthcare systems like never before and all efforts are now being put into controlling the COVID-19 crisis. We witness increasing morbidity, delivery systems that sometimes are on the brink of collapse, and some shameless rent seeking. However, besides all the challenges, there ar...

This perspective argues that for-profit hospitals will be heavily affected by epidemic crises, including the current coronavirus disease 2019 (COVID-19) outbreak. Policy-makers should be aware that for-profit hospitals in particular are likely to face financial distress. The suspension of all non-urgent elective surgery and the relegation of market...

This exploratory, mixed-methods study analyzes characteristics of the emerging for-profit nursing home industry in the Netherlands and identifies the interrelated set of factors (context, trends, and sector conditions) that contribute to its growth. Until recently, the Dutch nursing home sector relied almost exclusively on nonprofit providers. Even...

Coronavirus kan de zorg structureel veranderen A lle aandacht gaat momenteel uit naar het indam-men van het COVID-19-virus. De uitbraak van het virus heeft op de korte termijn twee verschil-lende effecten op de zorg: aan de ene kant is er in de acute keten meer capaciteit nodig. Aan de andere kant valt de zorg die even kan wachten massaal weg. Meer...

Background: Under a constrained health care budget, cost-increasing technologies may displace funds from existing health services. However, it is unknown what services are displaced and how such displacement takes place in practice. The aim of our study was to investigate how the Dutch hospital sector has dealt with the introduction of cost-increa...

Background: Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system...

Payment systems (PS) are at the core of the intermediation function between payers and recipients of care, which is complex because of the lack of functioning true markets in healthcare, and where the final outcome is significantly disconnected from what is paid for. There is a major distinction between retrospective and prospective PS. Incentives...

The context for health and hospital care will continue to change greatly. One area of change is ownership, between public, public-private partnership, private not-for-profit, and private for-profit. There are differences between formal and effective control, given that almost everywhere the state has a major role. Pseudo-markets can be created by a...

The determinants of health status depend on public health measures and curative and care services. “Hospitals” as organizations concentrate resources—physical capital and human capital, and technology—and thereby do things which other settings simply cannot. Yet, somehow, they mean different things to different people at different times and differe...

Background: Medicalization has been a topic of discussion and research for over four decades. It is a known concept to researchers from a broad range of disciplines. Medicalization appears to be a concept that speaks to all, suggesting a shared understanding of what it constitutes. However, conceptually, the definition of medicalization has evolve...

Background: The number of independent treatment centres (ITCs) has grown substantially. However, little is known as to whether the volume-quality relationship exists within this sector and whether other possible organisational factors mediate this relationship. The aim of this study is to gain a better understanding of such possible relationships....

Background: For older adults, a good transition from hospital to the primary or long-term care setting can decrease readmissions. This paper presents the 6-month post-discharge healthcare utilization of older adults and describes the numbers of readmissions and deaths for the most frequently occurring aftercare arrangements as a starting point in...

Aims: This study aimed to determine the characteristics of patients with heart failure and high costs (top 1% and top 2-5% highest costs in perspective of the general population) and to explore the longitudinal health care utilization and persistency of high costs. Methods and results: Longitudinal observational study using claims data from 2006...

New technologies may displace existing, higher‐value care under a fixed budget. Countries aim to curtail adoption of low‐value technologies, for example, by installing cost‐effectiveness thresholds. Our objective is to estimate the opportunity cost of hospital care to identify a threshold value for the Netherlands. To this aim, we combine claims da...

Objective: To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency. Data sources: Anonymous claims data (2013-2015) were used. We also obtained quality indicators from a semipublic platform. Study design: This study uses a comparative multilevel analysis,...

Objective: To reconstruct a sex-specific patient journey for Dutch persons with Parkinson's disease (PD) during the first 5 years after diagnosis. Method: We analyzed a national administrative medical claims database containing data of all patients newly diagnosed with PD between 2012 and 2016 in the Netherlands. We performed time-to-event analysis...

Background Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. B...

In a system of managed competition, selective contracting and patient choice reward providers for quality improvements through increases in patient numbers and revenue. We research whether these mechanisms function as envisioned by investigating the relationship between quality improvements and patient numbers in assisted reproduction technology in...

Introduction: Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable eff...

A central element of the 2006 health insurance reform in the Netherlands is strategic purchasing by health insurers. After a brief elaboration of the concept of trust this article discusses the trust of insured in the new purchasing role of health insurers. There are various indications of a trust problem or credible commitment problem in Dutch hea...