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Early Results from Adoption of Bundled Payment for Diabetes Care in the Netherlands Show Improvement in Care Coordination

The Issue

In an effort to promote care coordination and efficiency, U.S. health care purchasers are experimenting with provider reimbursement based on bundled payments—that is, single fees that cover all of the medical services involved in an episode of care.

What the Study Found

In this study, Dutch researchers draw lessons from the early experience of the Netherlands’ bundled payment system for diabetes care, chronic obstructive pulmonary disease care, and vascular risk management. Under the system, introduced in 2010, health insurers pay a single fee to a contracting “care group” for all the primary care services involved in a patient's care.

The authors, who include 2008–09 Commonwealth Fund Harkness Fellow Hubertus Vrijhoef, interviewed members of the Dutch ministry of health, as well as patient organizations, insurers, care groups, and providers. Thus far, the use of bundled payments seems to have improved care coordination among providers, led to greater adherence to care protocols, and increased transparency. Still, there are concerns about the domination of care groups by general practitioners, as well as the large price variations seen among care groups and the administrative burdens created by outdated information systems.


It is too early to tell whether the Dutch bundled payment system has affected the quality or costs of care. Noting the difficulty of bundling payments for patients with multiple conditions, the researchers conclude that the introduction of bundled payment “might turn out to be a useful step” toward developing a risk-adjusted integrated capitation payment system for multidisciplinary provider groups that care for a defined patient population.

Publication Details



D. H. de Bakker, J. N. Struijs, C. B. Baan et al., “Early Results from Adoption of Bundled Payment for Diabetes Care in the Netherlands Show Improvement in Care Coordination,” Health Affairs, Feb. 2012 31(2):426–33.