Joanna Marczak and Gerald Wistow
- Published in print:
- 2015
- Published Online:
- January 2017
- ISBN:
- 9781447305057
- eISBN:
- 9781447311539
- Item type:
- chapter
- Publisher:
- Policy Press
- DOI:
- 10.1332/policypress/9781447305057.003.0006
- Subject:
- Earth Sciences and Geography, Urban Geography
Commissioning plays a vital role in improving the efficiency of long-term care (LTC) systems as it can ensure an appropriate expenditure of public budgets. This chapter reviews changes in the ...
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Commissioning plays a vital role in improving the efficiency of long-term care (LTC) systems as it can ensure an appropriate expenditure of public budgets. This chapter reviews changes in the arrangements for commissioning services in recent years and explores the consequences of these changes for the system.
The attempts to reform LTC systems in industrialised countries have relied on a number of market mechanisms such as outsourcing of services, purchaser-provider split and a greater consumer choice for service users. It has been a working assumption of policy makers that these mechanisms will deliver a combination of improved quality of care and cost-efficiency, although countries vary in the degree of implementation of these instruments. The chapter thus explores different commissioning models in respect of: purchaser-provider structures; the extent of outsourcing; the use of tendering and contracts and the degree of user-involvement in the commissioning process. It also reviews the evidence about changes in the prices of services and the quality of care following marketization, it discusses the balance between the provision of home care and residential care in recent years and it considers the nature and extent of transaction costs associated with marketization.Less
Commissioning plays a vital role in improving the efficiency of long-term care (LTC) systems as it can ensure an appropriate expenditure of public budgets. This chapter reviews changes in the arrangements for commissioning services in recent years and explores the consequences of these changes for the system.
The attempts to reform LTC systems in industrialised countries have relied on a number of market mechanisms such as outsourcing of services, purchaser-provider split and a greater consumer choice for service users. It has been a working assumption of policy makers that these mechanisms will deliver a combination of improved quality of care and cost-efficiency, although countries vary in the degree of implementation of these instruments. The chapter thus explores different commissioning models in respect of: purchaser-provider structures; the extent of outsourcing; the use of tendering and contracts and the degree of user-involvement in the commissioning process. It also reviews the evidence about changes in the prices of services and the quality of care following marketization, it discusses the balance between the provision of home care and residential care in recent years and it considers the nature and extent of transaction costs associated with marketization.
