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Tytuł pozycji:

As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

Tytuł:
As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control
Autorzy:
Jonas Wohlin
Clara Fischer
Karin Solberg Carlsson
Sara Korlén
Pamela Mazzocato
Carl Savage
Holger Stalberg
Mats Brommels
Temat:
Value-based health care
Bundled payment
New public management
Competition
Patient choice
Public aspects of medicine
RA1-1270
Źródło:
BMC Health Services Research, Vol 21, Iss 1, Pp 1-9 (2021)
Wydawca:
BMC, 2021.
Rok publikacji:
2021
Kolekcja:
LCC:Public aspects of medicine
Typ dokumentu:
article
Opis pliku:
electronic resource
Język:
English
ISSN:
1472-6963
Relacje:
https://doaj.org/toc/1472-6963
DOI:
10.1186/s12913-021-06392-6
Dostęp URL:
https://doaj.org/article/723fda1fad684759b0fe8230c399d597  Link otwiera się w nowym oknie
Numer akcesji:
edsdoj.723fda1fad684759b0fe8230c399d597
Czasopismo naukowe
Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

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