‘Bundled payments’, the alternative payment model for maternity care in the Netherlands, has so far resulted in limited visible effects. Small changes in maternity care use and slightly reduced spending on maternity care are observed. Generally speaking, no changes in terms of the health of mothers and children are measured. These are the findings of a study conducted by the National Institute for Public Health and the Environment (RIVM). According to the organisations that voluntarily implemented the bundled payments, collaboration between maternity care providers has improved. At the same time, they mention the need for a better understanding of local issues and interventions that have been proven effective in tackling these issues and improving care quality, alongside bundled payments.
The results do vary widely between the different regions that implemented the bundled payments. In terms of health effects, for example, this includes differences in the numbers of preterm births, children with a low birth weight or women with severe postpartum haemorrhaging. These differences can be explained by the fact that the organisations themselves decide which measures to implement locally to improve collaboration and care.
Started as an experiment
Bundled payments were first implemented as an experiment, on a voluntary basis, in 2017. The aim was to improve and intensify collaboration between maternity care providers, and subsequently to improve the quality of the maternity care provided. For this purpose, partnerships were set up in six regions. These are known as integrated maternity care organisations (IMCOs). The idea is that the maternity care providers participating in the IMCO, such as obstetricians, midwives and postpartum care at-home providers, will coordinate care more efficiently.
Measuring impact across all regions is complex
Besides the lack of knowledge regarding local issues and effective interventions, and the various measures implemented by each IMCO, uncertainty about the future of bundled payments has also affected the findings. As a result of this uncertainty, IMCOs sometimes waited before implementing changes to care practice. Moreover, there have been several other initiatives aimed at improving collaboration in maternity care over the past years, such as the Solid Start programme. All of this combined, it is difficult to establish the direct impact of bundled payments.
Different method of paying for care
How the IMCOs are paid differs from other maternity care providers. The new method, known as bundled payments, means that an IMCO receives a bundled fee that covers the entire pregnancy, delivery and postpartum period. The IMCO subcontracts its participating providers and pays them for the care they provide. In the traditional, monodisciplinary payment model, providers are all paid separately per care activity. Since 1 January 2023, bundled payments are part of the regular payment model options. This means two systems are now in place (bundled and monodisciplinary). The maternity care regions decide, together with health insurers, which payment method they use.
Investing in knowledge
RIVM recommends helping the IMCOs map local issues and providing better information on the effective interventions that are available for these issues. RIVM also recommends a period of little or no policy changes, which can give IMCOs time to further improve collaboration and the quality of maternity care.
This study follows up on previous reports (in Dutch) and was commissioned by the Ministry of Health, Welfare and Sport.