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The aim of this paper is to explore the potential economic implications of these policy changes by drawing on the economics of co-operation and the transaction costs approach to longer term contracting

From competition to co-operation: new economic relationships in the National Health Service.

Health economics, no. 2 (1998): 105-119

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摘要

The Labour government has outlined its plans to 'replace' the competitive internal market with a more collaborative system based on partnership. Agreement amongst purchasers and providers is to be based on co-operation rather than competition. Longer term agreements covering periods of 3-5 years are to replace annual contracts within this...更多

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简介
  • In the White Paper, ‘The New NHS: Modern, Dependable’, the UK Labour government set out their vision for the future shape of the NHS in England [1].
  • One of the vehicles through which the new collaborative partnerships are to be forged is via the replacement of the annual contracting round with longer term funding agreements (LTAs) for the provision of health care services covering periods of 3–5 years.
  • What are the economic implications of these policy changes in the context of the NHS and are they likely to have the impact predicted by the government?.
  • The relevance to the NHS of these theoretical perspectives and experience in other non-health care sectors is discussed, before conclusions are drawn about the potential impact of the policy changes
重点内容
  • In the White Paper, ‘The New NHS: Modern, Dependable’, the UK Labour government set out their vision for the future shape of the NHS in England [1]
  • What are the economic implications of these policy changes in the context of the NHS and are they likely to have the impact predicted by the government?
  • The new government appears to be relying on the shift away from competitive relations and annual contracts towards collaborative partnerships between purchasers and providers and longer term funding agreements (LTAs), as a key mechanism for enhancing efficiency and reducing transaction costs in the NHS
  • We have shown that the theory and empirical evidence from non-health care sectors does suggest that co-operation and trust can play a central role in the efficient organisation of contractual arrangements in circumstances similar to those under which the NHS operate and it is reasonable to assume that some of the changes proposed in the White Paper will produce a range of benefits
  • We have argued that due to the nature of the relationships which already appear to prevail in the NHS and the nature of the contracts currently in operation, the shift envisaged by the Labour government is one of evolution rather than revolution
  • The extensive use of longer term contracts (LTCs) raises issues of whether purchasers will be able to extract reasonable performance from providers in the absence of competition or a credible threat of competition, and the role the government intends to give to contestability will influence the overall impact of LTCs on efficiency and quality
结果
  • The 1996/97 NAHAT contracting survey [42] found that only 8% of respondents were experiencing substantial problems in agreeing contracts to the extent that they were unlikely to be settled in time and perhaps this reflects growing experience of handling pre-contract disputes.
结论
  • The new government appears to be relying on the shift away from competitive relations and annual contracts towards collaborative partnerships between purchasers and providers and LTAs, as a key mechanism for enhancing efficiency and reducing transaction costs in the NHS.
  • The authors have shown that the theory and empirical evidence from non-health care sectors does suggest that co-operation and trust can play a central role in the efficient organisation of contractual arrangements in circumstances similar to those under which the NHS operate and it is reasonable to assume that some of the changes proposed in the White Paper will produce a range of benefits.
  • The extensive use of LTCs raises issues of whether purchasers will be able to extract reasonable performance from providers in the absence of competition or a credible threat of competition, and the role the government intends to give to contestability will influence the overall impact of LTCs on efficiency and quality
总结
  • Introduction:

    In the White Paper, ‘The New NHS: Modern, Dependable’, the UK Labour government set out their vision for the future shape of the NHS in England [1].
  • One of the vehicles through which the new collaborative partnerships are to be forged is via the replacement of the annual contracting round with longer term funding agreements (LTAs) for the provision of health care services covering periods of 3–5 years.
  • What are the economic implications of these policy changes in the context of the NHS and are they likely to have the impact predicted by the government?.
  • The relevance to the NHS of these theoretical perspectives and experience in other non-health care sectors is discussed, before conclusions are drawn about the potential impact of the policy changes
  • Objectives:

    The aim of this paper is to explore the potential economic implications of these policy changes by drawing on the economics of co-operation and the transaction costs approach to longer term contracting.
  • Results:

    The 1996/97 NAHAT contracting survey [42] found that only 8% of respondents were experiencing substantial problems in agreeing contracts to the extent that they were unlikely to be settled in time and perhaps this reflects growing experience of handling pre-contract disputes.
  • Conclusion:

    The new government appears to be relying on the shift away from competitive relations and annual contracts towards collaborative partnerships between purchasers and providers and LTAs, as a key mechanism for enhancing efficiency and reducing transaction costs in the NHS.
  • The authors have shown that the theory and empirical evidence from non-health care sectors does suggest that co-operation and trust can play a central role in the efficient organisation of contractual arrangements in circumstances similar to those under which the NHS operate and it is reasonable to assume that some of the changes proposed in the White Paper will produce a range of benefits.
  • The extensive use of LTCs raises issues of whether purchasers will be able to extract reasonable performance from providers in the absence of competition or a credible threat of competition, and the role the government intends to give to contestability will influence the overall impact of LTCs on efficiency and quality
基金
  • The authors acknowledge receipt of support from the Department of Health in the form of research funding for a programme of work within the Centre for Health Economics
研究对象与分析
data: 146
However, this does not reflect the extent to which disputes are settled informally, with the help of regional offices where required. A survey of contracting in 1993/4 found that over a third of the health authorities responding (n = 146), reported going to arbitration in the case of one or more contracts [41]. However, the 1996/97 NAHAT contracting survey [42] found that only 8% of respondents were experiencing substantial problems in agreeing contracts to the extent that they were unlikely to be settled in time and perhaps this reflects growing experience of handling pre-contract disputes

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