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Power and Purchasing: Why Strategic Purchasing Fails
- Source :
- The Milbank Quarterly
- Publication Year :
- 2020
-
Abstract
- Policy Points Strategically purchasing health care has been and continues to be a popular policy idea around the world. Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing. Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. Context Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. Methods We conducted three in-depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. Findings No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. Conclusions Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create.
- Subjects :
- contracting
media_common.quotation_subject
Original Scholarship
Context (language use)
Population health
State Medicine
03 medical and health sciences
0302 clinical medicine
Information asymmetry
Health care
Humans
Quality (business)
030212 general & internal medicine
Market power
Marketing
media_common
Netherlands
business.industry
030503 health policy & services
Health Policy
Politics
Public Health, Environmental and Occupational Health
Purchasing
United Kingdom
United States
purchasing
Value-Based Purchasing
England
Accountability
Organizational Case Studies
strategic purchasing
Power, Psychological
0305 other medical science
business
Delivery of Health Care
health systems
Program Evaluation
Subjects
Details
- ISSN :
- 14680009
- Volume :
- 98
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- The Milbank quarterly
- Accession number :
- edsair.doi.dedup.....c6128351df588890a53358fdc7ee2487