TY - JOUR
T1 - How managed a market? Modes of commissioning in England and Germany
AU - Sheaff, Rod
AU - Chambers, Naomi
AU - Charles, Nigel
AU - Exworthy, Mark
AU - Mahon, Ann
AU - Byng, Richard
AU - Mannion, Russell
PY - 2013
Y1 - 2013
N2 - Background: In quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so. Methods. Systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources. Results: The comparison exposes and contrasts two basic generic modes of commissioning:. 1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers. 2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power. Conclusions: Governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control.
AB - Background: In quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so. Methods. Systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources. Results: The comparison exposes and contrasts two basic generic modes of commissioning:. 1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers. 2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power. Conclusions: Governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control.
UR - http://www.scopus.com/inward/record.url?scp=84878237668&partnerID=8YFLogxK
U2 - 10.1186/1472-6963-13-S1-S8
DO - 10.1186/1472-6963-13-S1-S8
M3 - Article
C2 - 23734631
AN - SCOPUS:84878237668
SN - 1472-6963
VL - 13
SP - 1
EP - 10
JO - BMC Health Services Research
JF - BMC Health Services Research
IS - SUPPL.1
M1 - S8
ER -