Boer Henry, McCalman Janya, Doran Chris, Rush Amanda, Mitchell Bridgett, Fagan Ruth, Whiting Elizabeth, Kreis Megan, Johnson Hannah, Lyon David
Office of Indigenous Engagement, CQUniversity Australia, Level 2 Cairns Square, Cnr Abbott & Shields St, Cairns, QLD, 4881, Australia.
Jawun Research Centre, School of Health, Medical and Applied Sciences, CQUniversity Australia, Level 2 Cairns Square, Cnr Abbott & Shields St, Cairns, QLD, 4881, Australia.
BMC Health Serv Res. 2025 Jan 6;25(1):27. doi: 10.1186/s12913-024-12106-5.
Commissioning for health services has been implemented as one approach to improve the quality and access to healthcare for First Nations, regional and remote populations. This review systematically scoped the literature for studies that described or evaluated the governance, funding, implementation and outcomes from health service commissioning targeting these groups in Canada, Australia, Aotearoa/New Zealand and the United States (CANZUS nations).
Seventeen databases were searched for relevant peer reviewed and grey literature studies published in English from 2010 to 2023. Grounded theory methods were used to identify the enablers and strategies or processes that support commissioning and any challenges to implementation.
Overall, 29 Peer reviewed and 18 grey literature studies remained after screening. The studies reported enabling conditions for effective commissioning including operating models that were responsive to beneficiary needs, workforce and technical capability, flexibility and duration of contracts, adequate funding, and achievable health outcomes and indicators. Supporting strategies focussed on multi-actor collaboration, relationship building, and service innovation. Reported impacts included improved access to care, and self-determination and wellbeing for First Nations populations. Challenges related to inflexible funding, high transaction costs, overcompliance, and poor relationships. Most studies were process evaluations or descriptions of the application of commissioning to various health areas, with comparatively limited assessment of the impacts across the health system, or on health status.
Findings suggests that a relational model drives success in commissioning for health and wellbeing services for First Nations, regional and remote populations. The relational model presented in this review is supported by the following attributes: responsive, resourced, collaborative, equitable, innovative and self-determined: and when applied by multiple actors in the commissioning process can address the complex health and wellbeing needs of end users.
卫生服务委托已作为一种提高原住民、地区和偏远人口医疗保健质量和可及性的方法得以实施。本综述系统地梳理了文献，以查找描述或评估针对加拿大、澳大利亚、新西兰/奥特亚罗瓦和美国（CANZUS国家）这些群体的卫生服务委托的治理、资金、实施情况及成果的研究。
检索了17个数据库，查找2010年至2023年以英文发表的相关同行评审研究和灰色文献研究。运用扎根理论方法来确定支持委托的促成因素、策略或流程以及实施过程中面临的任何挑战。
筛选后，总共保留了29项同行评审研究和18项灰色文献研究。这些研究报告了有效委托的促成条件，包括响应受益方需求的运营模式、劳动力和技术能力、合同的灵活性和期限、充足的资金以及可实现的健康结果和指标。支持策略侧重于多行为体协作、关系建设和服务创新。报告的影响包括改善了医疗服务可及性，以及原住民的自决权和福祉。挑战涉及资金缺乏灵活性、交易成本高、过度合规以及关系不佳。大多数研究是对委托在各个卫生领域应用的过程评估或描述，对整个卫生系统影响或健康状况的评估相对有限。
研究结果表明，关系模型推动了为原住民、地区和偏远人口提供健康和福祉服务委托工作的成功。本综述中提出的关系模型具有以下属性的支持：响应性、资源充足性、协作性、公平性、创新性和自决性；并且当在委托过程中由多个行为体应用时，可以满足最终用户复杂的健康和福祉需求。
