Bart Noort has recently won the Karolinska Medical Management Centre/European Health Management Association (EHMA) Research Award for the draft version of his thesis. The PhD student’s research into the directive role played by healthcare purchasers in delivering chronic care was assessed as ‘the best contribution to the field of care management’. Noort was awarded a certificate and a cheque worth € 1,000.
‘I am obviously very happy with this special accolade’, says Noort. ‘I had to present my research alongside four other nominees at the annual European Health Management Association conference. The candidates had all recently obtained their PhD degrees, or were – like me – in the last phases of their programmes. It is therefore a wonderful and great honour to be able to take home the first prize.’
Noort’s PhD research, supervised by Professors Kees Ahaus and Taco van der Vaart, focuses on the directive role played by care procurement organizations in delivering chronic care. ‘Care procurement organizations such as health insurance companies and governments experience difficulties in fulfilling this directive role, both in private and public care systems’, says Noort. ‘They often focus on their administrative roles as budget holders. Previous research has shown that the directive role played by procurers can be supported by better financing, procurement regulations and outcome monitoring. But we have less understanding of how decisions and procurement strategies made by care procurers are realized in practice, and how they can be explained by differences between care systems.’
In a comparative study of England, Sweden and the Netherlands, Noort showed that the competition (or lack of competition) between care procurers, the type of procurement organization (clinical or commercial) and the freedom of choice of patients (whether the doctor functions as a gatekeeper or not) have an especially strong impact on the directive role finally chosen. Noort: ‘These three characteristics determine the extent to which care procurers focus on costs or on health, have a short or long-term vision, support care providers and are able to exercise influence on care providers.’
In addition, the strategies used by health insurance companies are strongly influenced by the three groups of stakeholders: governments, care providers and the insured. This is Noort’s conclusion on the basis of multi-year research. ‘Due to the sometimes conflicting medical, financial, relational and public interests of these stakeholders, health insurance companies are inclined to fall back into their traditional accounting strategies, despite their attempts to take on the role of orchestrator .’
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