CONTRACTS AND THE QUASI-MARKET IN COMMUNITY-HEALTH SERVICES

In the NHS quasi-market, contracts are the crucial mechanism through w hich purchasers influence providers of health care. Most attention has been given to the commissioning and contracting process in acute hosp ital services, However, there is another important but neglected secto r of health care - community health services (CHS) - in which the spec ification and implementation of contracts is particularly difficult, I n this article, three dimensions of contracting are analysed, illustra ted by qualitative evidence from case studies, concerning: the measure ment of activity; the estimation of costs and prices; and the monitori ng of outcomes and quality. This article argues that community health services are intrinsically problematic within the quasi-market, and su ggests that the nature of the services and the system of delivery mili tate 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 relatio nships between purchasers and providers.