A comparative analysis of the effectiveness of traditional and shared savings contracts for home care services

Purpose Shared savings contracts are seen as potentially useful tools for health-care provision in many countries. This study aims to investigate the effects of nuanced shared savings contracts on home nursing care. Design/methodology/approach This paper analyzed six Dutch home nursing providers participating in a shared savings contract experiment across 13 areas, covering approximately 40,000 insureds. A comparative analysis was performed two years after implementation, contrasting these areas with 13 reference areas and 99 neutral areas. Findings The results show no evidence that the shared savings contracts led to improvements, contrasting with earlier findings related to hospitals and general practitioners. This paper suggests, among other things, that the shared savings incentives may have been too limited in scope. In addition, factors such as the smaller scale of home nursing services and the more pronounced hierarchical distance between nurses and management, compared to hospitals and general practitioners, may have reduced the contracts’ impact. Practical implications This paper suggests that stronger or more enduring incentives in shared savings contracts may be needed to influence provider behavior. Focusing on active collaboration could be an alternative strategy. Since shared savings contracts are not always effective, continuous monitoring, and evaluation are also important. Social implications This study highlights the difficulties of improving care performance through contractual incentives in home nursing, which could have implications for health-care costs and patient care quality. Originality/value This research provides empirical insights into the effectiveness of nuanced shared savings contracts in home nursing, addressing a gap in the literature and offering practical recommendations for optimizing contract design.