Experiences of contracting: an overview of the literature

Abstract

Recent health policy debates in both developed and developing countries have been strongly influenced by a trend towards marketisation involving the selective introduction of a range of market mechanisms within the public health system. These developments are attributable to two main sets of influences. The first is the emergence of new trends in public sector management which identify private sector mechanisms as a solution to many of the problems currently experienced by the public sector in many parts of the world (Walsh 1995 Moore 1996). A second key driver of these reforms has been the accumulating evidence of the failure of health care systems throughout the world to meet key objectives of efficiency equity and responsiveness to users. Further factors have been growing demands for the extension of consumer choice and influence and increasing tension between limited resources and increasing demands on health care systems. Marketisation proposals and reform programmes have varied widely in terms of their scope the components of the health system they address and the specific mechanisms they rely upon. At their most ambitious reforms have aimed to create full quasi-markets in the health sector with competition in either or both the funding and supply of health care. Less ambitious reforms have aimed at introducing more limited market elements such as contractual relations between purchasers and providers. (excerpt)

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