2023-09-28 14:46:10 +00:00
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abstract: 'Objectives - Purchasing has been promoted as a key policy instrument to
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improve health system performance. Despite its widespread adoption,
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there is little empirical evidence on how it works, the challenges
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surrounding its implementation, its impact, and the preconditions for it
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to function effectively, particularly in low- and middle-income
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settings. The objective of this chapter is to analyze critically the
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extent to which purchasing could be, and has been used strategically in
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China and to identify modifications that are needed for purchasing to be
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effective in assuring that the government''s new funding for health care
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will result in efficient and effective health services.
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Methods - We present a conceptual framework for purchasing, which
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identifies three critical principal-agent relationships in purchasing.
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We draw on evidence from secondary data, results of other research
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studies, interviews, and the impact evaluation of a social experiment in
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rural China that explicitly used purchasing to improve quality and
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efficiency. This information is used to examine purchasing relationships
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in urban social health insurance (SHI), the rural medical insurance
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scheme, and purchasing of public health services.
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Findings - To date, use of strategic purchasing is limited in China.
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Both the urban and the rural health insurance schemes act as passive
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third-party payers, failing to take advantage of the opportunities to
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strengthen incentives to improve quality and efficiency. This may be
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because as government agencies, the extent to which the Ministries of
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Health and Labor and Social Security can act independently from provider
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interests, or act in the best interest of the population, is unclear.
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Other important challenges include ensuring adequate representation of
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the population''s views and preferences and making better use of the
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leverage provided by purchasing to create appropriate provider
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incentives, through better integration of financing and improved
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coordination among purchasers.
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Implications for policy - In designing purchasing arrangements,
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attention needs to be paid to all three principal agent relationships.
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Successful purchasing appears to require mechanisms to mobilize and
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represent community preferences and more strategic contracting with
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providers. More research is needed to strengthen the evidence on which
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purchasing arrangements work, which no not work, and under what
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conditions different purchasing configurations can work most
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effectively.'
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affiliation: 'Yip, W (Corresponding Author), Univ Oxford, Dept Publ Hlth, Hlth Econ
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Res Ctr, Oxford, England.
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Yip, Winnie, Univ Oxford, Dept Publ Hlth, Hlth Econ Res Ctr, Oxford, England.
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Hanson, Kara, London Sch Hyg \& Trop Med, Dept Publ Hlth \& Policy, Hlth Econ \&
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Financing Programme, London WC1, England.'
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author: Yip, Winnie and Hanson, Kara
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author_list:
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- family: Yip
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given: Winnie
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- family: Hanson
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given: Kara
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booktitle: 'INNOVATIONS IN HEALTH SYSTEM FINANCE IN DEVELOPING AND TRANSITIONAL
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ECONOMIES'
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da: '2023-09-28'
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doi: 10.1108/S0731-2199(2009)0000021011
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editor: Chernichovsky, D and Hanson, K
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files: []
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isbn: 978-1-84855-664-5
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issn: 0731-2199
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keywords-plus: DEVELOPING-COUNTRIES; SYSTEM
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language: English
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number-of-cited-references: '26'
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pages: 197-218
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papis_id: 919792f70852dd5e76d295044a77fafd
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ref: Yip2009purchasinghealth
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series: Advances in Health Economics and Health Services Research
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times-cited: '15'
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title: 'PURCHASING HEALTH CARE IN CHINA: EXPERIENCES, OPPORTUNITIES AND CHALLENGES'
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2023-10-01 08:15:07 +00:00
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type: article
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2023-09-28 14:46:10 +00:00
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unique-id: WOS:000270909400009
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usage-count-last-180-days: '0'
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usage-count-since-2013: '16'
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volume: '21'
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web-of-science-categories: Economics; Health Policy \& Services
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year: '2009'
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