Ashton Toni, Cumming Jacqueline, McLean Janet
Centre for Health Services Research and Policy, School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
Health Policy. 2004 Jul;69(1):21-31. doi: 10.1016/j.healthpol.2003.11.004.
This paper reports on the process and outcomes of contracting for health services in New Zealand between 1993 and 2000 when a purchaser-provider split was in place. Key factors that shaped the contracting environment were the legal framework, funding constraints, and the cultural and professional norms of contracting personnel. A lack of good information-especially on costs, volumes and quality-increased the costs of contracting and made monitoring and accountability difficult. Over time, however, the contracting process became simpler and less costly. Overall, the introduction of contracting generally improved the focus of providers on costs and volumes; led to greater clarity through specification of services; encouraged providers to focus on methods to improve quality; and enabled new styles of service provision from providers that had not traditionally received public funds for health services. Good relationships between purchasers and providers were seen as the key to successful contracting.
本文报告了1993年至2000年新西兰卫生服务签约的过程和结果，当时实行了购买方与提供方分离。塑造签约环境的关键因素包括法律框架、资金限制以及签约人员的文化和专业规范。缺乏良好的信息，尤其是关于成本、数量和质量的信息，增加了签约成本，并使监督和问责变得困难。然而，随着时间的推移，签约过程变得更加简单且成本更低。总体而言，签约的引入普遍提高了提供方对成本和数量的关注度；通过明确服务规范提高了清晰度；鼓励提供方关注提高质量的方法；并使那些传统上未获得公共卫生服务资金的提供方能够采用新的服务提供方式。购买方与提供方之间的良好关系被视为成功签约的关键。
