Track and Trace of Administrative Costs in the Dutch Long-Term Care System

Context: Practitioners and politicians alike emphasise the wish to reduce administrative costs (AC) in Dutch LTC, but a robust empirical body of evidence on the components, determinants and value of AC in LTC is absent. Neither has the expert consensus of ways to track and trace AC in LTC been sought. Objective(s): We investigated whether it is possible to reach consensus on operationalising AC in Dutch LTC. Successively we also explored whether the Dutch LTC reform in 2015 had the intended effect of reducing AC. Methods: We differentiated between AC for governing and financing LTC (macro), overhead costs of LTC delivery organisations (meso) and AC on the level of professional care delivery activities (micro). We identified possible data sources in grey literature and national accounts. The quality and completeness of identified data and potential determinants of AC were validated by experts via a survey and focus group discussions. Findings: We were able to reach agreement on how to track AC in Dutch LTC, but current research instruments and data systems are not robust and consistent enough to trace differences before and after the 2015 reform. Limitations: We did not investigate AC experienced by patients and self-selected participating experts. Implications: AC concern a considerable share of total LTC spending, but AC are hidden in regular health expenditure statistics. Our study highlights three approaches for a more sophisticated and fact-based policy debate on reducing low-value AC; defining AC on macro, meso and micro levels of the health care system, determining the underlying value/use of activities; and focusing on interactions of AC between system levels.