ANALYSING CONTRACTUAL ENVIRONMENTS: LESSONS FROM INDIGENOUS HEALTH IN CANADA, AUSTRALIA AND NEW ZEALAND

• 成果类型: Article
• 署名作者: Lavoie, Josee; Boulton, Amohia; Dwyer, Judith
• 署名单位: Massey University; Flinders University South Australia
• 刊物名称: PUBLIC ADMINISTRATION
• ISSN/ISSBN: 0033-3298
• DOI: 10.1111/j.1467-9299.2009.01784.x
• 发表日期: 2010
• 页码: 665-679
• 关键词: PRIMARY-CARE; services; people

摘要

Contracting in health care is a mechanism used by the governments of Canada, Australia and New Zealand to improve the participation of marginalized populations in primary health care and improve responsiveness to local needs. As a result, complex contractual environments have emerged. The literature on contracting in health has tended to focus on the pros and cons of classical versus relational contracts from the funder's perspective. This article proposes an analytical framework to explore the strengths and weaknesses of contractual environments that depend on a number of classical contracts, a single relational contract or a mix of the two. Examples from indigenous contracting environments are used to inform the elaboration of the framework. Results show that contractual environments that rely on a multiplicity of specific contracts are administratively onerous, while constraining opportunities for local responsiveness. Contractual environments dominated by a single relational contract produce a more flexible and administratively streamlined system.