How managed a market? Modes of commissioning in England and Germany

被引：11

作者：

Sheaff, Rod ^{[1
]}

Chambers, Naomi ^{[2
]}

Charles, Nigel ^{[1
]}

Exworthy, Mark ^{[3
]}

Mahon, Ann ^{[2
]}

Byng, Richard ^{[4
,5
]}

Mannion, Russell ^{[6
]}

机构：

[1] Univ Plymouth, Plymouth PL4 8AA, Devon, England

[2] Manchester Business Sch, Manchester, Lancs, England

[3] RHUL, London, England

[4] Univ Plymouth, Peninsula Sch Med, Plymouth PL4 8AA, Devon, England

[5] Univ Plymouth, Peninsula Sch Dent, Plymouth PL4 8AA, Devon, England

[6] Univ Birmingham, Birmingham B15 2TT, W Midlands, England

来源：

BMC HEALTH SERVICES RESEARCH | 2013年 / 13卷

关键词：

Disease Management Programme; Community Health Service; Social Health Insurance; Negotiate Order; General Medical Service Contract;

D O I：

10.1186/1472-6963-13-S1-S8

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background: In quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so. Methods: Systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources. Results: The comparison exposes and contrasts two basic generic modes of commissioning: 1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers. 2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power. Conclusions: Governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control.

引用

页数：10

共 27 条

[1] What B would otherwise do:: A critique of conceptualizations of 'power' in organizational theory [J].