CONTRACTING ARRANGEMENTS IN THE HEALTH STRATEGY CONTEXT. A REGIONAL APPROACH FOR SPAIN

Juan M. Cabasés (jmcabases@unavarra.es), Luis Gabilondo and Idoia Gaminde
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Juan M. Cabasés: Departamento de Economía-UPNA, https://www.unavarra.es/departamento-economia
Luis Gabilondo: MD, Department of Health, Government of Navarre
Idoia Gaminde: MSc, Depart ment of Health, Government of Navarre

No 11, Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra from Departamento de Economía - Universidad Pública de Navarra

Abstract: Background. Several different proposals have been made recently to reform the organisation, financing and management of the health care system in Spain. The aim is to obtain improved efficiency, without prejudicing the equity level already achieved, by creating a more competitive framework. However, current health strategies seem not to be in accord with these proposals. This paper approaches the issue of matching these two main components of the health systems, health strategy and contracts, and emphasises the need to develop contracting arrangements within the general health policy framework. Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants. Results and discussion. A review of regional health strategies and regional contracts developed in the 1990s is presented, followed by an analysis of the degree of incoherence between them. Then we discuss whether the programme contract can be an instrument guided by the health plan, commenting on its potential and limitations. Conclusion. The relationship between health strategy and health care management is practically non-existent in Spain. The need to insert the contract cycle within the broader framework of the planning cycle has led to proposals to adapt contracts and health plans to guarantee their coherence. This will require changes in the structure of both of these instruments and, probably, deeper structural modifications of the context within which both have been developed. To this aim, we make some recommendations for policy making.

Keywords: Health strategy; contracting; and regional; Spain (search for similar items in EconPapers)
Pages: 16 pages
Date: 2000
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Citations: View citations in EconPapers (3)

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