Data-driven commissioning to reduce type 2 diabetes related health disparities in The Netherlands: using key informant group interviews

Abstract

Highlights What are the main findings? This explorative study adds the fifteen factors influencing commissioners' ability to use data to reduce health disparities in type 2 diabetes and shows that commissioners experience barriers in actionable perspectives rather than in data capabilities. Additionally, it identifies three themes containing paradoxical mechanisms that hinder data-driven commissioning: equality, where efforts to ensure equal access lead to unfavorable unequal outcomes; quality, where a focus on evidence-based healthcare interventions limits effectiveness in reducing health disparities; and organizational sustainability, where conservative organizational behavior threatens long-term viability. What are the implications of the main findings? Current policy often focusses on data capabilities rather than the ability to implement data-driven approaches. To limit the rising healthcare usage associated with disparities, policies must be designed to break the paradoxical mechanisms. Further policy analyses are needed to better understand which conditions facilitate commissioners.Highlights What are the main findings? This explorative study adds the fifteen factors influencing commissioners' ability to use data to reduce health disparities in type 2 diabetes and shows that commissioners experience barriers in actionable perspectives rather than in data capabilities. Additionally, it identifies three themes containing paradoxical mechanisms that hinder data-driven commissioning: equality, where efforts to ensure equal access lead to unfavorable unequal outcomes; quality, where a focus on evidence-based healthcare interventions limits effectiveness in reducing health disparities; and organizational sustainability, where conservative organizational behavior threatens long-term viability. What are the implications of the main findings? Current policy often focusses on data capabilities rather than the ability to implement data-driven approaches. To limit the rising healthcare usage associated with disparities, policies must be designed to break the paradoxical mechanisms. Further policy analyses are needed to better understand which conditions facilitate commissioners.Abstract Background: Health disparities in individuals with type 2 diabetes result in an enormous amount of healthcare usage and are difficult to address. We examine how Dutch private, not-for profit health insurers, responsible for accessibility of care, use their claims data in the commissioning process to reduce health disparities. Objective: To identify factors influencing the possibility to reduce health disparities in commissioning based on data-driven insights. Methods: Key informant group interview data was analyzed using a hybrid deductive-inductive approach following the 6SQIuD framework to identify factors, their relationships, and potential for change, with results validated using a saturation, member and expert check. Results: From the 79 factors found, three were data capability-related and 76 were decision context-related. Fifteen main factors were found on socio-cultural, system, organizational and interpersonal levels. The factors in the decision context can be divided into the themes equality, quality and organizational sustainability. Conclusions: This study explored the factors influencing commissioners' ability to reduce disparities and the role of data. Interestingly, no main factors related to data capabilities were identified.Three paradoxes were seen after interpreting our data: equal access leads to unfavorable unequal outcomes; a focus on evidence-based healthcare interventions limits effectiveness in reducing health disparities; and conservative organizational behavior threatens long-term viability. Further policy analyses are needed to better understand which systemic and organizational conditions facilitate commissioners in addressing health disparities.