Volume 54 | Number 6 | December 2019

Abstract List

Florien M. Kruse MPP, Stef Groenewoud Ph.D., Femke Atsma PhD, Onno P. Galiën MSc, Eddy M. M. Adang PhD, Patrick P. T. Jeurissen PhD


To identify differences between independent treatment centers (ITCs) and general hospitals (GHs) regarding costs, quality of care, and efficiency.

Data Sources

Anonymous claims data (2013‐2015) were used. We also obtained quality indicators from a semipublic platform.

Study Design

This study uses a comparative multilevel analysis, controlling for case mix, to evaluate the performance of ITCs and GHs for patients diagnosed with cataract.

Data Collection

Reimbursement claims were extracted from existing claims databases of the largest Dutch health insurer. Quality indicators were obtained by external agencies through a mixed‐mode survey.

Principal Findings

There are no stark differences in complexity of cases for cataract care. ITCs seem to perform surgeries more frequently per care pathway, but conduct a lower number of health care activities per surgical claim. Total average costs are lower in ITCs compared with GHs, but when adjusted for case mix, the differences in costs are lower. The findings with the adjusted quality differences suggest that ITCs outperform GHs on patient satisfaction, but patients’ outcomes are similar.


This finding supports the postulation—based on the focus factory theory—that ITCs can provide more value for cataract care than GHs.