# Why Substantial Budget Reallocations Are Not and Should Not Be a Major Factor in Active Purchasing in Dutch Healthcare: Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands"

## TL;DR

This paper explains why shifting large budgets between healthcare providers is rare in the Netherlands and suggests better ways to improve healthcare efficiency.

## Contribution

The paper clarifies why substantial budget reallocations are not feasible in Dutch healthcare and proposes alternative strategies for active purchasing.

## Key findings

- Substantial budget shifts between providers are rare due to limited underperforming providers and patient reluctance.
- Strong regional dependencies and data quality issues hinder significant reallocations.
- Promising alternatives include collaboration and improved contracts.

## Abstract

This commentary discusses the study by Stadhouders et al, which analyzes budget reallocations among Dutch healthcare providers as a result of one form of active purchasing. The study assumes that healthcare purchasers aim to shift substantial funds from inefficient to efficient providers, yet finds little evidence of such shifts. This commentary explains more explicitly why substantial volume shifts are not and should not be a major factor in the Dutch context, citing factors such as the scarcity of underperforming providers, strong regional dependencies, data quality limitations, and patient reluctance to change provider. More promising avenues for active purchasing include fostering active collaboration and improving contractual arrangements.