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Contracting Arrangements In The Health Strategy Context. A Regional Approach For Spain

Author

Listed:
  • Juan M. Cabasés

    (Departamento de Economía-UPNA)

  • Luis Gabilondo

    (MD, Department of Health, Government of Navarre)

  • Idoia Gaminde

    (MSc, Depart ment of Health, Government of Navarre)

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 Design: Case studies, analysis of published and unpublished documents, and semi-structured interviews with key informants.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.

Suggested Citation

  • Juan M. Cabasés & Luis Gabilondo & Idoia Gaminde, 2000. "Contracting Arrangements In The Health Strategy Context. A Regional Approach For Spain," Documentos de Trabajo - Lan Gaiak Departamento de Economía - Universidad Pública de Navarra 0011, Departamento de Economía - Universidad Pública de Navarra.
    • Handle: RePEc:nav:ecupna:0011
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    References listed on IDEAS

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    1. Gaminde, Idoia, 1999. "Priorities in healthcare: a perspective from Spain," Health Policy, Elsevier, vol. 50(1-2), pages 55-70, December.
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    Cited by:

    1. Lager, Anton & Guldbrandsson, Karin & Fossum, Bjoorn, 2007. "The chance of Sweden's public health targets making a difference," Health Policy, Elsevier, vol. 80(3), pages 413-421, March.
    2. Busse, Reinhard & Wismar, Matthias, 2002. "Health target programmes and health care services--any link?: A conceptual and comparative study (part 1)," Health Policy, Elsevier, vol. 59(3), pages 209-221, March.
    3. Wismar, Matthias & Busse, Reinhard, 2002. "Outcome-related health targets--political strategies for better health outcomes: A conceptual and comparative study (part 2)," Health Policy, Elsevier, vol. 59(3), pages 223-241, March.

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