MACH : a methodology for analysing contracting in health care

ABSTRACT

A central theme underlying the proposals for reform of health systems worldwide is the introduction of market incentives. In the United Kingdom, the experience of an internal market with the separation of functions between purchasers and providers and the use of contracts, has been followed with interest by many governments. In countries such as Germany, separation of functions and contracting negotiations have been the norm for many decades. In the countries of central and eastern Europe and the newly independent states, the implementation of contracting is being considered in many reform proposals. This study suggests that there is a need to improve the understanding of contracting, its links with health policy, and the functions and characteristics of contracts, and proposes a methodology for analysing contracting in health care (MACH). Focusing on the context, the contracting process and on management of change for the development of contracting, the study applies the MACH to the experience of Germany and the United Kingdom. In Kyrgyzstan, where contracting mechanisms have not yet been implemented, the study uses the MACH for disucssing proposals for the development of contracting. Some of the strengths and weaknesses of the MACH identified during its application are discussed, major conclusions about contracting are presented and, in the light of the lessons learnt from the application of the methodology, recommendations for the development of contracting in Kyrgyzstan are made