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PubMed1985

Health care expenditure containment in the United States: strategies at the state and local level.

The current status of state and local strategies to contain health care expenditures in the United States is described. These strategies are classified as predominantly regulatory, competitive or voluntary. The actions of two major groups of purchasers of care--state government programs for the indigent and private employers--in support of expenditure containment strategies are discussed as well. The large number of approaches to expenditure containment currently being attempted, and their diverse character, are hypothesized to be a result not only of increased health care inflation and the concern it causes purchasers of care, but also of fundamental changes in the health care industry in the United States which have realigned traditional provider interest groups.

Budgets↗
PubMed1996

Essential skills for purchasing--the views of directors of public health and health authority chief executives.

Since the NHS reforms, health authorities have been purchasing health care and have been advised that public health considerations must inform all NHS activities, and that the Director of Public Health must be supported by a team of qualified support staff. This survey of directors of public health and health authority chief executives in England shows the skills currently available to support health authority purchasing, and the perceived importance of this wide range of skills to the purchasing process. Future models of purchasing will need to ensure access by purchasers to public health and multi-disciplinary advice.

England↗
PubMed1997

A hospital pioneers reform of its state's procurement code.

In today's changing healthcare marketplace, hospitals across the US are rapidly moving toward developing integrated healthcare delivery networks. In addition, the emergence of managed care and the growing trend toward capitation have compelled hospitals to reduce costs in response to these changes. Moreover, this impetus to provide quality care at reduced cost has affected the purchasing behavior of many hospitals, forcing material managers to pursue innovative procurement methods. This article describes how the Medical University of South Carolina (MUSC) Medical Center, (Charleston, SC) obtained significant savings in purchasing as a result of pioneering legislative reforms in the procurement process.

Competitive Bidding↗
PubMed1995

Commissioning for health.

The NHS internal market offers community nurses unprecedented opportunity to achieve, through influencing the purchasing process, real improvements in health and health care. Shirley Goodwin outlines what she, as a purchaser, looks for when she commissions community nursing services.

Community Health Nursing↗
PubMed2003

Should general practitioners purchase health care for their patients? The total purchasing experiment in Britain.

Until relatively recently, general practitioners (GPs) have been allowed to work independently, with no requirement to consider the resource implications of their referral and prescribing decisions. In order to align the interests of GPs with the overall objectives of health systems a number of countries have introduced primary care based capitation, funds pooling and budget holding either as experiments or as an overall policy. Are these experiments and policies likely to work? This paper presents evidence from the UK total purchasing experiment, which was the first major quasi-market development in the NHS to be independently evaluated from the outset. Total purchasing gave volunteer groups of practices freedom to purchase all hospital and community health services for their patients. The evidence suggests that whilst GPs have great potential as purchasers, they also have considerable limitations. The expectation that they will be able to improve the quality of patient experience of care, or to alter the use of resources, may not be generally realised. GP-based purchasing may be more appropriate where the task is to alter the balance or location of care between hospital and extramural settings. However, budgetary incentives are not 'magic potions' which have similar effects on behaviour wherever they are introduced. Holding budgets and having independent contracts, while important pre-requisites for being taken seriously in a quasi-market, were not sufficient for effective total purchasing. The paper concludes that health systems should not only value innovation and experimentation and encourage learning from evaluative research; they should also recognise the importance of supportive circumstances for any innovation to effect real and sustained change.

Budgets↗
PubMed1994

Purchaser quality measures: progressing from wants to needs.

BACKGROUND: Purchaser demands for hospital performance data are based on the fundamental nature of benefits management-the need to reconcile costs and results. The evolution from cost-based delivery of services to prospectively priced, value-based services is occurring concurrently with the adoption of quality improvement approaches. ISSUES: The "wants" for data that purchasers articulate sometimes hide the "needs" the wants were meant to satisfy. A more efficient information agenda can be developed by exploring the nature of these needs for patients, who receive the benefits, and purchasers, who pay for them. Characteristics such as sensitivity, importance, feasibility, validity, and believability for outcome measures are discussed and then used to evaluate three popular measures of quality: cesarean section (C-section), mammography screening, and coronary artery bypass graft mortality rates. CONCLUSION: By focusing on disease/treatment/outcome-specific measurement systems, information sets helping patients, providers, and purchasers to achieve the best possible quality of outcome can be efficiently developed.

Cost-Benefit Analysis↗
PubMed1998

From contracts to service agreements: what can be learned from total purchasing?

Total purchasing is an experimental extension of GP fundholding through which GP practices can purchase community, secondary and tertiary services not included in standard fundholding budgets, for their registered patient populations. The paper presents selected findings from a study of contracting by TPPs during the first year of purchasing, concentrating on the perceived relationship between aspects of the contracting process and the achievement of TPP's strategic objectives. These findings are of relevance to the development of commissioning by primary care groups in light of the Government's proposal that contracts be replaced by long-term service agreements as competition within the NHS internal market is replaced by more collaborative arrangements between commissioners and providers. The paper identifies features of the contracting process which have been instrumental to the achievement of TPPs' service development objectives and may need to be preserved to ensure effective commissioning within the context of the new service agreements.

Budgets↗
PubMedDate not supplied

Association health plans: what's all the fuss about?

Policymakers have tried to address the problem of the uninsured and to help small businesses with rising premiums by encouraging associations to offer coverage. Although supporters and opponents have made claims about the potential impact of this strategy, the association market has not been studied in depth. Examining current standards might explain why proponents seek changes. This paper discusses states' approaches to regulating health insurance offered by associations, including "self-insurance," as well as existing state exemptions from state insurance laws that otherwise would apply to coverage sold to small businesses, self-employed people, and individual purchasers. We also examine market problems such as insolvency and fraud.

Accounting↗