Maternity Care Bundled Payments In The Netherlands: Changes In Health Outcomes, Spending, And Care Delivery After 5 Years

Bundled payments are increasingly used worldwide, yet long-term evidence remains limited, particularly in maternity care. This study evaluated five-year changes after bundled payments in maternity care in the Netherlands. Using a difference-in-differences design and 2008-21 nationwide data, we compared 22,307 pregnancies across six regions that adopted bundled payments in 2017 with 69,496 pregnancies in twenty matched control regions. Outcomes included maternity care use; maternal and neonatal health; and spending during pregnancy, childbirth, and the postnatal period. Bundled payments were associated with an 8.9 percent reduction in midwifery-to-obstetric transfers during delivery, a 1.1 percent decline in home births, and a US$121 reduction in spending per pregnancy. Estimated effects varied across regions and over time. No changes were observed in maternal or neonatal health. These findings suggest that the shifts in clinical care processes through bundled payments in Dutch maternity care modestly slowed spending, although they were likely not sufficient to improve health outcomes.