By Alexander S. Preker, John C. Langenbrunner
With a different specialise in strategic deciding to buy and contracting of providers from nongovernmental services, this name studies how one can make public spending on healthiness care extra effective and equitable in constructing international locations. it's endorsed that: * experiments and pilot tasks for bettering public zone hospitals should still specialize in venture readability and organizational simplification; * courses for bettering the composition of usage may still scan with funds to shoppers and with health and wellbeing hard work strength composition and coaching; and * tasks to draw prone to rural components should still use specific deferred reimbursement contracts to enhance tracking.
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Extra info for Spending Wisely: Buying Health Services for the Poor
The term soon fell into disrepute among critics for being reductionist— focused too narrowly on the relationship between payers and providers, on “widget counting,” on cost, and on volumes. ” they would ask. Purchasing tried to address these shortcomings by including elements of “strategic direction” and “intelligence” in the contractual arrangement. ). Purchasing can and often does refer to relationships with both public and private providers. Many social health insurance funds “purchase” services from networks of public providers run by ministries of health and local governments as well as the private sector.
Yet reforming payment incentives and other aspects of the health labor force—such as civil service reform, resource allocation, and purchasing of labor, and employment practices—are highly sensitive politically and may have large fiscal implications. In chapter 14, “Purchasing Pharmaceuticals,” Ulrika Enemark, Anita Alban, Enrique C. Seoane-Vazquez, and Andreas Seiter observe that drug expenditures account for a large share of total healthcare costs in developing countries. Most drugs are being paid for directly by patients out of pocket, which is often a significant financial burden for the poor.
Is it not easier to just set aside a budget to produce services that are needed and let providers get on with their business? Would this not avoid the added hassle of letting and managing contracts, monitoring outcomes, and settling disputes when disagreements arise during this process? Is public production not the only solution when capacity to contract and regulate is low? These were precisely the questions that policymakers began asking during the 1980s and 1990s. There was a growing consensus that the path to greater state effectiveness and rapid development depends on matching the role of governments to their capabilities and changing the incentive structure in the public sector.