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Classical versus relational approaches to understanding controls on a contract with independent GPs in South Africa

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  • Natasha Palmer
  • Anne Mills

Abstract

Contracts have played a central role in public sector reforms in developed countries over the last decade, and research increasingly highlights their varied nature. In low and middle income countries the use of contracts is encouraged but little attention has been paid to features of the setting that may influence their operation. A qualitative case study was used to examine different dimensions of a contract with private GPs in South Africa. Features of the contract are compared with the notions of classical and relational contracts. Formal aspects of the contract such as design, monitoring and resort to sanctions were found to offer little control over its outcome. The relational rather than classical model of contracting offered a more meaningful framework of analysis, with social and institutional factors found to play an important role. In particular, the individual nature of GP practices highlighted the role played by individual motivation where a contract exercised little formal control. Due to the similarity of factors likely to be present, results are argued to be relevant in many other LMIC settings, and policy‐makers considering contracts for clinical services are advised to consider the possibility of experiencing a similar outcome. Copyright © 2003 John Wiley & Sons, Ltd.

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  • Natasha Palmer & Anne Mills, 2003. "Classical versus relational approaches to understanding controls on a contract with independent GPs in South Africa," Health Economics, John Wiley & Sons, Ltd., vol. 12(12), pages 1005-1020, December.
    • Handle: RePEc:wly:hlthec:v:12:y:2003:i:12:p:1005-1020
    DOI: 10.1002/hec.792
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    References listed on IDEAS

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    1. Joanna Coast, 1999. "The appropriate uses of qualitative methods in health economics," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 345-353, June.
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    3. Tony Scott & Alan Maynard, 1991. "Will the new GP contract lead to cost effective medical practice?," Working Papers 082chedp, Centre for Health Economics, University of York.
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    1. Natasha Palmer & Anne Mills, 2012. "Contracting-out Health Service Provision in Resource- and Information-poor Settings," Chapters, in: Andrew M. Jones (ed.), The Elgar Companion to Health Economics, Second Edition, chapter 23, Edward Elgar Publishing.
    2. Donato, Ronald, 2010. "Extending transaction cost economics: Towards a synthesised approach for analysing contracting in health care markets with experience from the Australian private sector," Social Science & Medicine, Elsevier, vol. 71(11), pages 1989-1996, December.
    3. Palmer, Natasha & Mills, Anne, 2005. "Contracts in the real world: Case studies from Southern Africa," Social Science & Medicine, Elsevier, vol. 60(11), pages 2505-2514, June.
    4. Oliveira Cruz, Valeria & McPake, Barbara, 2010. "The "aid contract" and its compensation scheme: A case study of the performance of the Ugandan health sector," Social Science & Medicine, Elsevier, vol. 71(7), pages 1357-1365, October.
    5. Laamanen, Ritva & Simonsen-Rehn, Nina & Suominen, Sakari & Øvretveit, John & Brommels, Mats, 2008. "Outsourcing primary health care services--How politicians explain the grounds for their decisions," Health Policy, Elsevier, vol. 88(2-3), pages 294-307, December.
    6. Guinness, Lorna, 2011. "What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?," Social Science & Medicine, Elsevier, vol. 72(12), pages 1939-1947, June.

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