ANALYSING CONTRACTUAL ENVIRONMENTS: LESSONS FROM INDIGENOUS HEALTH IN CANADA, AUSTRALIA AND NEW ZEALAND
ANALYSING CONTRACTUAL ENVIRONMENTS: LESSONS FROM INDIGENOUS HEALTH IN CANADA, AUSTRALIA AND NEW ZEALAND
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DOI：
10.1111/j.1467-9299.2009.01784.x
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发表时间：
2010-01-01
影响因子：
3.5
通讯作者：
Dwyer, Judith
中科院分区：
文献类型：
--
作者：
Lavoie, Josee;Boulton, Amohia;Dwyer, Judith
保健承包是加拿大、澳大利亚和新西兰政府用来改善边缘化人口参与初级保健和更好地满足当地需求的一种机制。因此，出现了复杂的合同环境。在卫生合同的文献往往侧重于从资助者的角度来看，古典与关系合同的利弊。本文提出了一个分析框架，探讨依赖于一些经典的合同，一个单一的关系型合同或两者的混合的合同环境的优势和劣势。土著订约环境的例子被用来为框架的拟订提供信息。结果表明，依赖于多种具体合同的合同环境在行政上是繁重的，同时限制了地方响应的机会。由单一关系契约主导的契约环境产生了一个更灵活和行政上更精简的系统。
Contracting in health care is a mechanism used by the governments of Canada, Australia and New Zealand to improve the participation of marginalized populations in primary health care and improve responsiveness to local needs. As a result, complex contractual environments have emerged. The literature on contracting in health has tended to focus on the pros and cons of classical versus relational contracts from the funder's perspective. This article proposes an analytical framework to explore the strengths and weaknesses of contractual environments that depend on a number of classical contracts, a single relational contract or a mix of the two. Examples from indigenous contracting environments are used to inform the elaboration of the framework. Results show that contractual environments that rely on a multiplicity of specific contracts are administratively onerous, while constraining opportunities for local responsiveness. Contractual environments dominated by a single relational contract produce a more flexible and administratively streamlined system.