Distributed Governance of Life Care Agreements via Public Databases.doc (original) (raw)

Government capacity to contract: health sector experience and lessons

Public Administration and Development, 1998

Using case-study material of contracting for clinical and ancillary services in the health care sector of developing countries, this article examines the capacities required for successful contracting and the main constraints which developing country governments face in developing and implementing contractual arrangements. Required capacities dier according to the type of service being contracted and the nature of the contractor. Contracting for clinical as opposed to ancillary services poses considerably greater challenges in terms of the information required for monitoring and contract design. Yet, in some of the case-studies examined, problems arose owing to government's limited capacity to perform even very basic functions such as paying contractors in a timely manner and keeping records of contracts negotiated. The external environment within which contracting takes place is also critical; in particular, the case-studies indicate that contracts embedded in slow-moving, rule-ridden bureaucracies will face substantial constraints to successful implementation. The article suggests that governments need to assess required capacities on a service-by-service basis. For any successful contracting, basic administrative systems must be functioning. In addition, there should be development of guidelines for contracting, clear lines of communication between all agents involved in the contracting process, and regular evaluations of contractual arrangements. Finally, in cases where government has weak capacity, direct service provision may be a lowerrisk delivery strategy. #

Implementing Consumer Choice in Long-term Care: The Impact of Individual Budgets on Social Care Providers in England

Social Policy & Administration, 2011

In common with many advanced welfare states, England has increasingly relied on consumerist principles to deliver both greater quality and improved efficiency in the long-term care system. The Individual Budget (IB) pilots marked the next step in this process, through a new system of funding whereby greater control of resources is given to service users, in lieu of direct in-kind care provision. IBs have the potential to transform the market for care services as well as the relationships between key stakeholders within it. Purchasing will increasingly be shaped by the demands of IB holders, with providers expected to deliver a wider range of personalized services. What will this mean for providers, and what can they do to prepare for these changes? These questions are relevant not just in England but in many other countries adopting similar mechanisms for devolving control over the design, delivery and funding of care to the end-user. The article explores the early impact of IBs on providers' services, on their workforces, and on the administrative implications for providers of managing IBs. The study finds that providers were positive about the opportunities for better-quality services that IBs can bring about. However, participants highlighted a number of obstacles to their effectiveness, and reported a range of potentially adverse administrative and workforce consequences which have the potential to jeopardize the consumerist policy objectives of increased choice and efficiency.

Payment by Outcome: A Commissioner's Toolkit

2011

With emerging interest in contracting for outcomes, this study re viewed the lessons to be learned from a number of sectors where some form of payment-by-outcome had been employed in the past - welfare-to-work, offender management, the management of long-term health conditions, pharmaceutical pricing and foster care.

Handbook on Contracting Out Government Functions and Services in Fragile Situations

The OECD is a unique forum where the governments of 33 democracies work together to address the economic, social and environmental challenges of globalisation. The OECD is also at the forefront of efforts to understand and to help governments respond to new development and concerns, such as corporate governance, the information economy and the challenges of an ageing population. The Organisation provides a setting where governments can compare policy experiences, seek answers to common problems, identify good practice and work to co-ordinate domestic and international policies.

Organizational form and performance: An empirical investigation of nonprofit and for-profit job-training service providers

Journal of Policy Analysis and Management, 2000

While research on the distinctions between for-profit and nonprofit organizations and their changing service sector shares is vast, there is comparatively little empirical evidence on the consequences of their differing attributes for social program outcomes. This article presents research on publicly subsidized for-profit and nonprofit job-training service providers, namely whether organizational form influences client enrollment, service delivery activities, or performance, as measured in terms of participant outcomes. The findings show that nonprofit providers were not more likely to serve more disadvantaged clients and that neither for-profit nor nonprofit service providers were consistently more effective in increasing participants' earnings and employment rates. When performance incentives were included in service providers' contracts, contractors of all forms performed significantly better across all participant outcomes examined.

Doing the splits: contracting issues in the New Zealand health service

Health Policy, 1993

The purchaser-provider split is an integral part of the New Zealand and UK health care reforms. The split is seen as an opportunity to introduce competition by increasing the number of players. The assumption is that competition among providers, purchasers or indeed funders, increases efficiency and provides more consumer choice. This paper looks at the issue of contracting in the New Zealand health services within the framework of transaction cost analysis. It examines evidence about the effects of formal contracting rather than the more traditional, informal negotiations that take place within a hierarchy. A number of potential problems with an indiscriminate provider split are highlighted and the conclusion drawn, that the outcome of such a split is likely to be more unpredictable than official expectations. In the absence of pilots, monitoring the implementation will be critically important to be able to compare the outcomes of different ways of organising the health care system.

Contracting for Welfare Services in Italy

Journal of Social Policy, 2006

The 1990s witnessed the spread and broadening in Europe of different types of relationships between public administration and private organisations (both for-profit and non-profit), derived from the two main categories of contracting out and accreditation. These models, linked to the process of developing new modes of governance, also focus on forms of contracting between providers and users of services. This contractual configuration of local welfare systems appears to encourage 'civil society' and recipients to play a more active role in designing interventions and putting them into practice. Nonetheless, several questions still remain to be answered, mainly concerning the different position adopted by the beneficiaries in the case of intervention theoretically aimed at ensuring or increasing their 'freedom of choice'. This article sets out to analyse these questions with specific reference to the implementation of the Italian legal reform of social services. The field of observation covers interventions based on economic benefits looking to promote recipients' independence. Our intention is to focus on whether and how the present structures incorporate and elaborate this impulse towards change, with particular reference to the new configuration of the users' own position.

Contracting for welfare services in Italy

Journal of Social Policy, 2006

The 1990s witnessed the spread and broadening in Europe of different types of relationships between public administration and private organisations (both for-profit and non-profit), derived from the two main categories of contracting out and accreditation. These models, linked to the process of developing new modes of governance, also focus on forms of contracting between providers and users of services. This contractual configuration of local welfare systems appears to encourage 'civil society' and recipients to play a more active role in designing interventions and putting them into practice. Nonetheless, several questions still remain to be answered, mainly concerning the different position adopted by the beneficiaries in the case of intervention theoretically aimed at ensuring or increasing their 'freedom of choice'. This article sets out to analyse these questions with specific reference to the implementation of the Italian legal reform of social services. The field of observation covers interventions based on economic benefits looking to promote recipients' independence. Our intention is to focus on whether and how the present structures incorporate and elaborate this impulse towards change, with particular reference to the new configuration of the users' own position.