Abstract

RIVM (National Institute for Public Health and the Environment) is investigating the effects of bundled payments for maternity care on maternity care utilization, health outcomes for mothers and children, and spending. The theory behind this alternative payment model is that it should improve the quality of maternity care by strengthening collaboration among the different maternity care providers. In order to implement bundled payments, a new legal entity needs to be set up in each participating region. These so-called integrated maternity care organisations (in Dutch: integrale geboortezorgorganisaties, IGOs) were voluntarily set up in various regions in the Netherlands. In these IGOs, maternity care is organised in such a way that all involved providers, such as gynaecologists, midwives and postpartum care providers, can coordinate and cooperate more effectively. The IGO negotiates a bundled fee with the health insurers, which covers the full range of maternity care services during pregnancy, delivery and the postpartum period. The IGO subsequently divides the money among the different care providers depending on the amount and type of care they provided. This model creates a more flexible reimbursement structure, compared to the traditional fee-for-service model in which maternity care providers are paid individually by the health insurers based on specific, predefined care activities.

After five years of bundled payments (2017-2021), we found small differences in maternity care utilization and slower spending growth in IGOs. We found no changes in health outcomes for the IGOs combined. For preterm births, low birthweight and postpartum haemorrhaging, we found no effects for the IGOs combined but differing effects for the individual IGOs. For example, we found an increase in children born with low birthweight in some IGOs and in others we found a decrease.

The differences in effects between IGOs is partly because IGOs make their own decisions on which interventions to implement and which changes to make to improve care quality. This makes it difficult to study the effect of bundled payments on various outcomes for all IGOs combined. The IGOs themselves also indicate that they do not know exactly which effective interventions are available and when they are useful in their region. This is why RIVM recommends helping the IGOs map local issues and providing better information on the effective interventions that are available for these issues.

Bundled payments for maternity care were initiated in 2017 by the Ministry of Health, Welfare and Sport on an experimental and voluntary basis. It has been implemented as a regular payment model for maternity care by law since January 1, 2023. This means that there are currently two payment models for maternity care available (i.e., bundled payments and the traditional fee-for-service model), and regions can choose which one to use.