A bundle of joy? Evaluating bundled payments for maternity care in the Netherlands

Abstract

This dissertation examines the effects of bundled payments for maternity care in the Netherlands. This payment reform was introduced experimentally in 2017 to improve collaboration and coordination across disciplines in maternity care and thereby promote maternal and infant health and quality of care. The study evaluates the model and provides insights for future policy decisions on payment reform in maternity care. The evaluation combines quantitative, qualitative, and mixed-methods research and incorporates various perspectives.

The findings demonstrate that observational data offer new opportunities for evaluating payment reform. The bundled payment model also appears to influence providers’ behaviour, as reflected in changes in utilization and slower growth in expenditures, without affecting maternal or infant health outcomes. Stakeholders agree on the importance of payment reform but differ in their views on its objectives and design. Clients primarily value their personal care experiences, which should be incorporated into future evaluations.

For future payment reforms, it is crucial to define objectives and success criteria in advance, align a realistic evaluation plan with the policy process, and establish who holds the policy mandate for continuation, scaling up, or termination. As payment reform is an essential component of healthcare transformation, it is important to continue developing it both within maternity care and across the broader healthcare system.