Hostname: page-component-7dd5485656-tbj44 Total loading time: 0 Render date: 2025-10-30T19:17:37.217Z Has data issue: false hasContentIssue false
  • English
  • Français

Contracts and the Quasi-market in Community Health Services

Published online by Cambridge University Press:  12 June 2009

Rob Flynn ,
Susan Pickard  and
Gareth Williams
Get access Rights & Permissions [Opens in a new window]

Abstract

In the NHS quasi-market, contracts are the crucial mechanism through which purchasers influence providers of health care. Most attention has been given to the commissioning and contracting process in acute hospital services. However, there is another important but neglected sector of health care – community health services (CHS) – in which the specification and implementation of contracts is particularly difficult. In this article, three dimensions of contracting are analysed, illustrated by qualitative evidence from case studies, concerning: the measurement of activity; the estimation of costs and prices; and the monitoring of outcomes and quality. This article argues that community health services are intrinsically problematic within the quasi-market, and suggests that the nature of the services and the system of delivery militate against provider competition. It is argued that CHS have more in common with ‘clans’ and ‘networks’ rather than markets and hierarchies, and that this requires collaborative rather than adversarial relationships between purchasers and providers.

Information

Type
Articles
Information
Journal of Social Policy , Volume 24 , Issue 4 , October 1995 , pp. 529 - 550
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Audit Commission (1992), Homeward Bound, NHS Report no. 7, HMSO, London.Google Scholar
Audit Commission (1993), Their Health, Your Business, HMSO, London.Google Scholar
Bartlett, W. (1991), ‘Quasi-markets and contracts’, Policy and Politics, 11, 3: 53–61.Google Scholar
Beardshaw, V. (1992), ‘Prospects for nursing’, in Beck, E., Lonsdale, S., Newman, S. and Patterson, D. (eds.), In the Best of Health? Chapman Hall, London.Google Scholar
Bowling, A. (1991), Measuring Health: a Review of Quality of life Measurement Scales, Open University Press, Milton Keynes.Google Scholar
Bradach, J. L. and Eccles, R. C. (1991), ‘Price, authority, and trust’, in Thompson, G., Frances, J., Levacic, R. and Mitchell, J.. Markets, Hierarchies and Networks, Sage, London.Google Scholar
Bysshe, J. (1990), ‘District experience on Project 2000 nursing (London)’, Journal of Clinical Practice, Education and Management, 4: 24–7.Google Scholar
Calnan, M. and Gabe, J. (1991), ‘Recent developments In general practice: a sociological analysis’ in Gabe, J., Calnan, H. and Bury, M., The Sociology of the Health Service, Routledge, London.Google Scholar
Chamberlain, A. and Tennant, A. (1991), ‘Health service reforms and access to specialist services’, British Journal of Rheumatology, 30: 322–4.CrossRefGoogle ScholarPubMed
Common, R. and Flynn, N. (1992), Contracting for Care, Rowntree Foundation, York.Google Scholar
Cowley, S. (1993), ‘Skill-mix: value for whom?’, Health Visitor, 66: 5, 166–71.Google Scholar
Department of Health (1990), Caring for People: Community care in the Next Decade and Beyond, Policy Guidance, HMSO, London.Google Scholar
Dingwall, R., Rafferty, A. M. and Webster, C. (1988), An Introduction to the Social History of Nursing, Routledge, London.Google Scholar
Ewles, L. (1993), ‘Hope against hype’, Health Service Journal, 26 08, 30–1.Google Scholar
Ferlie, E. (1994), ‘The creation and evolution of quasi markets in the public sector’, Policy and Politics, 22: 2, 105–12.CrossRefGoogle Scholar
Ferlie, E., Cairncross, L. and Pettigrew, A. (1993), ‘Understanding internal markets in the NHS’, in Tilley, I. (ed.), Managing the Internal Market, Paul Chapman, London.Google Scholar
Fitzpatrick, R. (1994), ‘Health needs assessment, chronic illness, and the social sciences’, in Popay, J. and Williams, G. (eds.), Researching the People's Health, Routledge, London.Google Scholar
Glennerster, H., Matsaganis, M. and Owens, P. (1992), A Foothold for Fundholdlng, Research Report 12, Kings Fund Institute, London.Google Scholar
Granovetter, M. (1985), ‘Economic action and social structure: the problem of embeddedness’, American Journal of Sociology, 91: 3, 481–510.CrossRefGoogle Scholar
Harrison, S. and Pollitt, C. (1994), Controlling Health Professionals, Open University Press, Buckingham.Google Scholar
Harrison, S. and Wistow, G. (1992), ‘The purchaser/provider split in English health care’, Policy and Politics, 20: 2, 123–30.CrossRefGoogle Scholar
Hudson, B. (1992), ‘Quasi-markets in health and social care in Britain’, Policy and Politics, 20: 2, 131–42.CrossRefGoogle Scholar
Hunter, D. (1993), ‘The internal market’, in Tilley, I. (ed.), Managing the Internal Market, Paul Chapman, London.Google Scholar
Jackson, C. (1993), ‘A tale of two teams’, Health Visitor, 6: 2, 41.Google Scholar
Kerrison, S. (1993), ‘Contracting and the quality of medical care’, in Tilley, I. (ed.), Managing the Internal Market, Paul Chapman, London.Google Scholar
Khan, M. and Landes, R. (1993), The Role of the Public Health Nurse: a Review of the International Literature (Occasional Paper 2), Public Health Research and Resource Centre, Bolton, Salford, Trafford and Wigan Health Authorities.Google Scholar
Knapp, M., Wistow, G., Forder, J. and Hardy, B. (1993), ‘Markets for social care’, paper presented at the ‘Quasi-markets – emerging findings’ Conference, SAUS, Bristol.Google Scholar
Le Grand, J. (1990), ‘Quasi-markets and social policy’, Studies in Decentralisation and Quasi-Markets, 1. SAUS, Bristol.Google Scholar
Le Grand, J. (1994), ‘Evaluating the NHS reforms’, in Robinson, R. and Le Grand, J. (eds.), Evaluating the NHS Reforms, Policy Journals, Hermitage.Google Scholar
Le Grand, J. and Bartlett, W. (1993), ‘The theory of quasi-markets’, in Le Grand, J. and Bartlett, W. (eds.), Quasi-markets and Social Policy, Macmillan, London.CrossRefGoogle Scholar
Lightfoot, J., Baldwin, S. and Wright, K. (1992), Nursing by Numbers, SPRU, University of York.Google Scholar
Long, A. F. (1994), ‘Assessing health and social outcomes’, in Popay, J. and Williams, G. (eds.), Researching the People's Health, Routledge, London.Google Scholar
Long, A. F. and Mercer, G. (1987), Health Manpower: Planning, Production, and Management, Croom Helm, London.Google Scholar
Lyall, S. (1993), ‘Payment by results’, Health Service Journal, 21 10, 11.Google Scholar
MacKerrell, D. (1993), ‘Contract pricing’, in Tilley, I. (ed.), Managing the Internal Market, Paul Chapman, London.Google Scholar
Maheswaran, S. and Appleby, J. (1992), ‘Building quality standards into contracts’, Health Direct, 09, 6.Google Scholar
Maynard, A. (1993), ‘Creating competition in the NHS’, in Tilley, I. (ed.), Managing the Internal Market, Paul Chapman, London.Google Scholar
NHSME (1990), Working for Patients: NHS Trusts – a working guide, HMSO, London.Google Scholar
NHSME (1992), Guidance on GP Fundholder extension of HCS, EL(92)48, NHSME, Leeds.Google Scholar
NHSME (1993), Priorities and Planning Guidance 1994–95 EL(93)54, NHSME, Leeds.Google Scholar
Netten, A. (1993), ‘Early learning’, Health Service Journal, 22 07, 24–6.Google Scholar
Ong, B. N. (1993), The Practice of Health Services Research, Chapman Hall, London.CrossRefGoogle Scholar
Ouchi, W. G. (1991), ‘Markets, bureaucracies and clans’, in Thompson, G. et al. , Markets, Hierarchies and Networks, Sage, London.Google Scholar
Powell, W. W. (1991), ‘Neither market nor hierarchy: network forms of organization’, in Thompson, G. et al. (eds.), Markets, Hierarchies and Networks, Sage, London.Google Scholar
Ranade, W. et al. (1992), Perspectives on the market, NAHAT Project Paper 6, National Association of Health Authorities and Trusts, Birmingham.Google Scholar
Robinson, R. (1993), ‘Checks and balances’, Health Service Journal, 8 07 24–5.Google Scholar
Seedhouse, D. (1994), Fortress NHS: a philosophical review of the National Health Service, John Wiley and Sons, Chichester.Google Scholar
Shickle, D., Veral, C. and Donnelly, P. (1993), ‘Simply sausages?’, Health Service Journal, 2 09, 30–1.Google Scholar
Weindling, P. (1992), ‘From infectious to chronic diseases: changing patterns of sickness in the nineteenth and twentieth centuries’, in Wear, A. (ed.), Medicine in Society: Historical Essays, Cambridge University Press, Cambridge.Google Scholar
Williamson, O. E. (1983), Markets and Hierarchies, Free Press, New York.Google Scholar