How do purchasers’ control mechanisms affect healthcare outcomes? Cancer care services in the English National Health Service

ABSTRACT

The purchaser–provider co-operation model is a way of increasing efficiency and quality in healthcare services. Risks associated with this model, including goal misalignment and information asymmetry, are managed through control mechanisms. Based on data from 12 clinical commissioning groups (purchasers of cancer care) in the English National Health Service, this paper describes the control mechanisms used to facilitate purchaser–provider co-operation and identifies good practices in using different control mechanisms. Effective control mechanisms were found to include stakeholder involvement (social control); co-operation and partnerships with providers (process control); and monitoring and service outcome measures for provider (outcome control). The paper fills an important gap in the literature—little scholarly attention has to date been paid about how purchaser and provider relationships are managed ex post and how performance is affected.

IMPACT

This study on cancer care clinical commissioning groups provides guidance for managers and policy-makers on the control mechanisms that can help manage the risks associated with purchaser–provider co-operation models in healthcare. Close interactions and developing trust with the health providers were found to be important in terms of care outcomes. Stakeholder involvement in care pathway development, co-operation, interactions and partnerships with cancer care providers, overall contract management and service outcome measures for providers are the pre-requisites for fruitful collaborations in care pathway development.

KEYWORDS:

• Agency theory
• commissioning
• contract management
• control mechanisms
• healthcare
• NHS
• public procurement
• purchaser–provider