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BMC Health Services Research

, 13:S8

First Online: 24 May 2013DOI: 10.1186-1472-6963-13-S1-S8

Cite this article as: Sheaff, R., Chambers, N., Charles, N. et al. BMC Health Serv Res 2013 13Suppl 1: S8. doi:10.1186-1472-6963-13-S1-S8


BackgroundIn quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control -media of power- for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so.

MethodsSystematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources.

ResultsThe comparison exposes and contrasts two basic generic modes of commissioning:

1. Surrogate planning English NHS, in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers.

2. Case-mix commissioning Germany, in which managerial performance, an -episode based- negotiated order and juridical controls appear the dominant media of commissioner power.

ConclusionsGovernments do not necessarily maximise commissioners- power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners- use of provider competition as a means of control.

List of abbreviations usedAPMSAlternative Provider Medical Services contract, England

CCGClinical Commissioning Group

CQUINCare Quality and Innovation programme England

DRGDiagnostic Related Group

D-DRGDeutsche German DRG

EBMEvidence-based medicine

EHCIEuro Health Consumer Index

GB-AGemeinsame Bundesausschuss Federal negotiating body, Germany

GMSGeneral Medical Services contract, England

GPGeneral practitioner

HRGHealth Resource Group English DRGs

IQWIGInstitut für Qualität und Wirtschaftlichkeit in Gesundheitswesen Institute for Health Care Quality and Economy, Germany

MDKMedizinische Dienst der Krankenkassen Medical service for SHIs, Germany

NHSNational Health Service England

NICENational Institute for Health and Clinical Excellence

PCTPrimary Care Trust England

PMSPersonal Medical Services contract, England

QOFQuality and Outcome Framework of GP contracts, England

SGBSozialgesetzbuch Book of social law, Germany

SHISocial health insurance - insurer.

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Autor: Rod Sheaff - Naomi Chambers - Nigel Charles - Mark Exworthy - Ann Mahon - Richard Byng - Russell Mannion


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