Social Development and Public Governance > Social Development > Health and HIV/AIDS
Public Purchaser-Private Provider Contracting for Health Services
By William Savedoff, Katherine Slack (04/01, SOC-111, En)
Governments in Latin America and the Caribbean are increasingly contracting with private sector healthcare providers either to harness the resources of the private sector and capture some of the advantages of competitive markets or simply to ensure that some services are provided in the most remote geographical areas. The types of healthcare services provided under these arrangements are varied and changing quickly. Many countries are learning through trial and error, experimenting with different contract types and finally picking the one that works best. Others are just beginning to use the most basic types of contracts.
Few studies have been performed to analyze the contracting experiences of individual countries, and fewer still to compare the experiences of several countries. Many governments believe their circumstances are so unique that they cannot learn from other countries? efforts. While this is true, it remains useful for policymakers to know what contract types exist and which have been successfully adopted in which situations. There must be lessons to be learned from the experiences of countries with more developed markets that can be applied in the countries just beginning to experiment with contracting.
Three sets of issues are commonly held to determine the success or failure of contracts: the incentives created by the provider payment mechanism; the adequacy of the accompanying monitoring and information systems; and the readiness and suitability of the service, the market, and the key actors. By considering the existing examples we should be able to identify a number of problems that countries have found within each of these three categories, and suggest some ways to avoid them.
The exercise would be more useful still if the contracts could be categorized in some way and ranked objectively by feature, e.g. by degree of provider autonomy and by adequacy of Quality Assurance (QA) systems. This would help researchers compare contracts objectively, understand which contracts were most suitable for which market environment, and decide which most needed revision in each. With further work to study the performance of different types of contracts under different circumstances, we could even begin to predict the effectiveness of contract designs.
In response to the research gap just described, this paper?s objectives are:
- To create a database giving a range of examples of contracting between public and private sectors in Latin America and the Caribbean for use by researchers (searching for case study examples to examine in more detail) and by project teams (looking for examples of other countries with comparable experiences).
- To categorize the examples by key contractual and institutional characteristics and identify patterns.
- To use the examples to illustrate the key issues for consideration when implementing healthcare contracting, using as sources the database, interviews with health experts, and relevant publications.
- To devise a method of ranking the examples by key subjective characteristics (e.g. level of provider autonomy, adequacy of Quality Assurance mechanism) to aid future comparison and help identify the benefits and problems of different systems.
- To draw conclusions with regard to system performance and health outcomes.
Last updated: 06/01/07
