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Alternative Payment Models


Admission requirements

Successful completion of Governance is advised.

If you are not enrolled in the MSc programme Population Health Management but you consider taking this course as an elective, please contact our study advisor.


Economic thinking plays an important role in population health management at all levels. Patients, providers, and payers involved in the health care sector make decisions and are part of it based on economic incentives, which are often manipulated to achieve the overarching system goals. Knowledge of the underlying logic and employed terminology of payment reforms, are useful to influence health policy and increase value of health care services.

This course is intended to learn students how to analyze current population health management issues through the application of basic economic principles. No previous economics training is required. The course will begin with an introduction to health economics. Among the topics we will discuss are health insurance coverage, provider payer incentives and competition. Subsequently, the basic concepts, key designs elements, implementation strategies and evaluation method of payment reforms will be introduced. Discussed topics are base payment models (e.g. fee-for-services, capitation) and alternative payment models (e.g. pay-for-performance, shared savings, bundled payment, global payments). As payment reforms aim to change provider behavior, we will also focus on the role of behavioral economics. The course consists of multiple online lectures, working groups, group assignments and individual assignments.

Course objectives

Upon successful completion of this course, the student:

  • can recognize health economic issues as they arise in health care practice and health policy around the world and

  • can critique and form economic arguments for and against particular health policies and argue the rationale for the need for alternative payment models

  • can describe key health economic concepts including efficiency, asymmetric information, agency, moral hazard, and adverse election

  • can describe key concepts regarding alternative payment models including shared savings and bundled payment

  • can apply insights from behavioural economic theories within the design of alternative payment models of behavioral economics including loss aversion

  • can reflect on the different base- and add-on payment models, their incentives and potential consequences for provider behaviour.


All course and group schedules are published on MyTimeTable.

The exam dates have been determined by the Education Board and are published in MyTimeTable.
It will be announced in MyTimeTable and/or Brightspace when and how the post-exam feedback will be organized.

Mode of instruction

  • Lectures

  • Group work

  • Online education

Assessment method

Students are assessed according to the following three obligatory components:

Week 1-2 – Online: Peer review assessment (20%, no required minimum grade)

Week 3 – On Campus: Group presentation (30%, no required minimum grade)

Week 4 – Final week: Final assignment (50%, required minimum grade: 6,0)

All components combined make up the final grade for the course. It is compulsory to participate in each of the components in order to receive a grade.
Details on the assessment can be found in the assessment plan on Brightspace.

A final grade of 6,0 minimum is considered sufficient. If the result is less than 6,0 or if the student did not participate in one of the components, the student is given the opportunity to retake the assessment as one assignment that covers all the learning goals of the course.

Final grades between 5,0 and 6,0 will be rounded:

  • 5,0-5,4 → 5,0

  • 5,5-6,0 → 6,0

Reading list

The reading list can be found on Brigthspace. The material consistst of presentations and pdf files. There is no need to purchase literature, as the presented material is not commercialized.


Registration must be completed via MyStudyMap. Registration in MyStudyMap gives you automatic access to the course in Brightspace. For more information, please visit the Leiden University website for students.


Dr. Jeroen N. Struijs -


This course is a combination of online education and on campus education at the Leiden University Health Campus in The Hague.