Research Group Financial-Economic Advise on Innovation, HU University of Applied Sciences Utrecht, Heidelberglaan 15, Utrecht, 3584 CS, the Netherlands.
Department of Rehabilitation, Physical Therapy Science and Sports, Brain, Centre Rudolf Magnus, Utrecht University, University Medical Centre Utrecht, Utrecht, the Netherlands.
BMC Health Serv Res. 2022 Aug 3;22(1):990. doi: 10.1186/s12913-022-08383-7.
Since 2006, business principles have been introduced to foster efficient healthcare by way of managed competition. Managed competition is expressed by a contract between a health insurer and a physiotherapy primary healthcare organisation (PTPHO). In such a managed environment, PTPHOs have to attain treatment service quality and financial PTPHO-centred outcomes Research shows that business model designs may enhance organisation-centred outcomes. A business model is a design (efficiency or novelty) of how a firm transacts with customers, partners, and vendors; how it connects with markets. However, research on managed competition contract and business model designs, in relation to PTPHO-centred outcomes is new to the healthcare literature. PTPHOs may not know how business model designs enhance outcomes. This study aims to delineate the relations between business model efficiency and novelty, and PTPHO-centred outcomes, while accounting for managed competition contract in Dutch healthcare.
A quantitative cross-sectional design was adopted. Using a questionnaire, the relations between managed competition, business model efficiency and novelty, and PTPHO-centred outcomes were investigated among PTPHO managers (n = 138). Theory-based expectations were set up and multiple linear regression analyses were applied.
Managed competition and business model efficiency show no relation with PTPHO-centred outcomes. Moderation of the business model efficiency and PTPHO-centred outcomes relation by managed competition contract is not detected. Business model novelty shows a positive relation with PTPHO-centred outcomes. Moderation of the business model novelty and PTPHO-centred outcomes relation by managed competition contract is found.
There seem to be positive relations between business model novelty and PTPHO-centred outcomes on its own and moderated by managed competition contract. No relations seem to exist with business model efficiency. This implies that the combination of persistent use of health insurer-driven managed competition contracts and a naturally efficient PTPHOs may have left too few means for these organisations to contribute to healthcare reforms and attain PTPHO-centred outcomes. Organisation-driven innovation could stretch system-level regulations and provide room for new business models. Optimising contracts towards organisation-driven healthcare reform, including novelty requirements and corresponding reimbursements is suggested. PTPHO managers may want to shift their attitudes towards novel business models.
自 2006 年以来，商业原则被引入医疗保健领域，通过管理竞争来提高效率。管理竞争通过健康保险公司和物理治疗初级保健组织 (PTPHO) 之间的合同来体现。在这种管理环境下，PTPHO 必须达到治疗服务质量和以 PTPHO 为中心的财务结果。研究表明，商业模式设计可以提高以组织为中心的结果。商业模式是公司与客户、合作伙伴和供应商交易的设计（效率或新颖性）；它如何与市场连接。然而，与以 PTPHO 为中心的结果相关的管理竞争合同和商业模式设计的研究在医疗保健文献中是新的。PTPHO 可能不知道商业模式设计如何提高成果。本研究旨在阐明商业模型效率和新颖性与以 PTPHO 为中心的结果之间的关系，同时考虑到荷兰医疗保健中的管理竞争合同。
采用定量横断面设计。使用问卷，调查了 PTPHO 经理（n=138）之间管理竞争、商业模式效率和新颖性与以 PTPHO 为中心的结果之间的关系。根据理论预期，进行了多元线性回归分析。
管理竞争和商业模式效率与以 PTPHO 为中心的结果之间没有关系。未检测到管理竞争合同对商业模式效率和以 PTPHO 为中心的结果关系的调节作用。商业模式新颖性与以 PTPHO 为中心的结果呈正相关。发现管理竞争合同对商业模式新颖性和以 PTPHO 为中心的结果关系的调节作用。
在没有管理竞争合同的情况下，商业模式新颖性与以 PTPHO 为中心的结果之间似乎存在正相关关系，并且受到管理竞争合同的调节。与商业模式效率似乎不存在关系。这意味着持续使用保险公司驱动的管理竞争合同和自然高效的 PTPHO 的组合可能已经为这些组织提供了太少的手段来为医疗改革做出贡献并实现以 PTPHO 为中心的结果。组织驱动的创新可以拓展系统层面的监管，并为新商业模式提供空间。建议优化合同，以支持组织驱动的医疗改革，包括新颖性要求和相应的报销。PTPHO 经理可能希望改变他们对新颖商业模式的态度。
