Substitution of care

Substitution of care requires better alignment of incentives Shifting care from secondary to primary care—substitution—has been on the policy agenda for years. A new dissertation shows that incentives for patients, healthcare providers, and insurers are not always aligned with this policy goal. Deductible hampers use of primary care Analyses of routinely collected healthcare data reveal that the mandatory deductible is a significant barrier. Patients who have not yet used up their deductible make less use of physiotherapy for knee and hip osteoarthritis. COPD patients also follow referrals to medical specialists more quickly when their deductible has already been spent. Delays in following up on referrals are associated with a higher risk of ICU admission, indicating possible negative health consequences. Increasing primary care capacity promotes substitution When mental health practice nurses (POH-GGZ) are sufficiently deployed, the use of basic and specialized mental healthcare decreases. This underscores the importance of adequate capacity in primary care. However, the relationship between waiting times and the deployment of POH-GGZ remains unclear. Role of health insurers: opportunities and limitations Health insurers can facilitate substitution but face competition rules, hospital bargaining power, and complex funding structures. At the same time, long-term contracts, regional collaboration, and digital innovations offer opportunities. Current risk equalization may unintentionally discourage substitution, which argues for adjustments toward equalization based on conditions rather than care utilization. Routine healthcare data and policy measures Combining electronic health record (EHR) and claims data provides detailed insight into care pathways, which is essential for monitoring care utilization patterns and evaluating policy. It is important to consider how new policy measures affect data collection so that future policies can be evaluated even more effectively.