Journal of health services research & policy
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J Health Serv Res Policy · Jan 2012
Commissioning processes in primary care trusts: a repeated cross-sectional survey of health care commissioners in England.
To determine the extent to which primary care trusts (PCTs) in England employed processes associated with quality commissioning and to assess whether changes occurred in these processes during a policy drive to improve commissioning. ⋯ PCT commissioners reported clinical engagement in the majority of commissioning initiatives, a shift towards partnership commissioning, and increased involvement of patients and public in the development of initiatives. The new model of commissioning in England through clinical commissioning groups will need to improve on these processes if it is to demonstrate a higher quality approach to commissioning.
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J Health Serv Res Policy · Jan 2012
Provider diversity in the English NHS: a study of recent developments in four local health economies.
To assess the impact of provider diversity on quality and innovation in the English NHS by mapping the extent of diverse provider activity and identifying the differences in performance between Third Sector Organisations (TSOs), for-profit private enterprises, and incumbent organizations within the NHS, and the factors that affect the entry and growth of new providers. ⋯ There is scope to increase the participation of diverse providers in the NHS but care must be taken not to damage public accountability, overall productivity, equity and NHS providers (especially acute hospitals, which are likely to remain in the NHS) in the process.
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To analyse how competition is experienced and characterized by NHS and independent sector acute care providers in the English National Health Service (NHS). ⋯ The providers' view of the market and the relevance of historical relationships and loyalties suggest fine grained variations in competition which is consistent with a relational rather than structural approach to competition. Also the evidence on embeddedness of relationships implies that collaboration might be a strong lever for quality improvement locally. Finally, some of the agreements found might be deemed in breach of the rules of competition but they may well be in the interests of patients and taxpayers, with implications for regulation in publicly funded health care systems.
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J Health Serv Res Policy · Oct 2011
Moving (realistically) from volume-based to value-based health care payment in the USA: starting with medicare payment policy.
Employers and policy-makers in the USA are desperate to slow the rate at which health expenditures grow. Changing how most health care providers are reimbursed will be necessary to achieve this. Although both politically and practically daunting, massive restructuring or replacement of fee-for-service (FFS) reimbursement is what is most required. ⋯ Altering this reality and fostering the expansion of exemplary delivery models-such as the Mayo Clinic or Geisinger Health System-requires change in how providers behave. And changing behavior often starts with adjusting how providers are paid. Medicare is the programme and payer most capable of using payment reform to catalyze delivery system reform.