BUSINESS MODEL EFFICIENCY AND NOVELTY, AND OUTCOME WHILE ACCOUNTING FOR MANAGED COMPETITION: QUANTITATIVE STUDY AMONG DUTCH PHYSIOTHERAPY PRIMARY HEALTHCARE ORGANISATIONS

R. Ijntema^1,2, D.-J. Barten³, H. Duits⁴, B. Tjemkes⁵, C. Veenhof⁶

¹HU University of Applied Sciences, Financial-Economic Innovation, Utrecht, Netherlands, ²HU University of Applied Sciences, Innovative Human Movement Care (Physiotherapy) Research Groups, Utrecht, Netherlands, ³University Medical Centre Utrecht, Department of Rehabilitation, Physical Therapy Science and Sports, Brain Centre Rudolf Magnus, Utrecht University, Utrecht, Netherlands, ⁴HU University of Applied Sciences, Research Group Financial-Economic Innovation, Utrecht, Netherlands, ⁵VU University Amsterdam, Department of Management and Organisation Studies, Amsterdam, Netherlands, ⁶University Medical Centre Utrecht, Department of Rehabilitation, Physical Therapy Science and Sports, Brain Center Rudolf Magnus, Utrecht University, Utrecht, Netherlands

Background: 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.

Purpose: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Implications: 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.

Funding acknowledgements: Not applicable.

Keywords:
Business model design
Managed competition contract
Physiotherapy organisation-centred outcomes

Topics:
Professional issues: business skills, leadership, advocacy & change management
Primary health care
Globalisation: health systems, policies & strategies

Did this work require ethics approval? Yes

Institution: HU University of Applied Sciences Utrecht

Committee: Institutional Review Board Ethical Committee Research Healthcare Domain

Ethics number: Reference number: 159-000-2021_Rutger IJntema