Unintended effects of reimbursement schedules in mental health care

Rudy Douven, Rianne Remmerswaal, I (Ilaria) Mosca

Research output: Contribution to journalArticleAcademicpeer-review

13 Citations (Scopus)


We evaluate the introduction of a reimbursement schedule for self-employed mental health care providers in the Netherlands in 2008. The reimbursement schedule follows a discontinuous discrete step function —once the provider has passed a treatment duration threshold the fee is flat until a next threshold is reached. We use administrative mental health care data of the total Dutch population from 2008 to 2010. We find an “efficiency” effect: on the flat part of the fee schedule providers reduce treatment duration by 2 to 7% compared to a control group. However, we also find “unintended” effects: providers treat patients longer to reach a next threshold and obtain a higher fee. The data shows gaps and bunches in the distribution function of treatment durations, just before and after a threshold. About 11 to 13% of treatments are shifted over a next threshold, resulting in a cost increase of approximately 7 to 9%.
Original languageEnglish
Pages (from-to)139-150
Number of pages12
JournalJournal of Health Economics
Publication statusPublished - 6 Apr 2015

Research programs

  • EMC NIHES-05-63-02 Quality


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