Durham Jo, Bains Amara
Faculty of Medicine & Biomedical Sciences, The University of Queensland, School of Public Health, Herston, Brisbane, Queensland, 4006, Australia.
Queensland Alliance for Mental Health, 1/78 Logan Road, Woolloongabba, Brisbane, Queensland, 4102, Australia.
Syst Rev. 2015 Mar 25;4:32. doi: 10.1186/s13643-015-0025-3.
In most developed nations, there has been a shift from public services to a marketisation of public goods and services - representing a significant reform process aiming to transform the way in which community-based human services, such as health, are delivered and consumed. For services, this means developing the capacity to adapt and innovate in response to changing circumstances to achieve quality. The availability of rigorous research to demonstrate whether a market approach and contestability, in particular, is a coherent reform process is largely absent. Contestability operates on the premise that better procurement processes allow more providers to enter the market and compete for contracts. This is expected to create stimulus for greater efficiencies, innovation and improved service delivery to consumers. There is limited understanding, however, about how community-based providers morph and re-configure in response to the opportunities posed by contestability. This study focuses on the effect of a contestability policy on the community-managed mental health sector.
METHODS/DESIGN: A realist review will be undertaken to understand how and why the introduction of contestability into a previously incontestable market influences the ways in which community-based mental health providers respond to contestability. The review will investigate those circumstances that shape organisational response and generate outcomes through activating mechanisms. An early scoping has helped to formulate the initial program theory. A realist synthesis will be undertaken to identify relevant journal articles and grey literature. Data will be extracted in relation to the emerging contextual factors, mechanisms and outcomes and their configurations. The analysis will seek patterns and regularities in these configurations across the extracted data and will focus on addressing our theory-based questions.
Increasingly, community-based mental health markets are moving to contestability models. Rigorous research is needed to understand how such markets work and in what contexts. The knowledge gained from this study in community-based mental health will provide valuable lessons in how contestability works, in what circumstances and who benefits when. The results of the proposed research will be useful to policy-makers and may be applicable in other contexts beyond the community-based mental health sector.
PROSPERO CRD42015016808.
在大多数发达国家，公共服务已从公共服务转向公共产品和服务的市场化——这是一个重大的改革进程，旨在改变诸如医疗保健等基于社区的人类服务的提供和消费方式。对于服务而言，这意味着要培养适应能力和创新能力，以应对不断变化的情况，从而实现质量目标。目前，关于市场方法，特别是可竞争性是否是一个连贯的改革进程，缺乏严格的研究来予以证明。可竞争性基于这样一个前提，即更好的采购流程能让更多供应商进入市场并竞争合同。这有望刺激提高效率、推动创新并改善向消费者提供的服务。然而，对于基于社区的供应商如何因应可竞争性带来的机遇而进行形态转变和重新配置，人们了解有限。本研究聚焦于可竞争性政策对社区管理的心理健康部门的影响。
方法/设计：将进行一项现实主义综述，以了解将可竞争性引入此前无竞争的市场如何以及为何会影响基于社区的心理健康供应商对可竞争性的反应方式。该综述将调查那些塑造组织反应并通过激活机制产生结果的情况。早期的范围界定有助于形成初始的项目理论。将进行现实主义综合分析，以识别相关的期刊文章和灰色文献。将提取与新出现的背景因素、机制和结果及其配置相关的数据。分析将在提取的数据中寻找这些配置中的模式和规律，并将重点解决基于我们理论的问题。
基于社区的心理健康市场正日益转向可竞争性模式。需要进行严格的研究，以了解此类市场如何运作以及在何种背景下运作。从本研究中获得的关于基于社区的心理健康的知识，将为可竞争性如何发挥作用、在何种情况下发挥作用以及谁能从中受益提供宝贵的经验教训。拟议研究的结果将对政策制定者有用，并且可能适用于基于社区的心理健康部门之外的其他背景。
PROSPERO CRD42015016808
