Journal Article

Power and Purchasing

GREER, SCOTT L., KLASA, KATARZYNA, VAN GINNEKEN, EWOUT

2020

Overview

Policy Points Strategically purchasing health care has been and continues to be a popular policy idea around the world. Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing. Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. Context Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. Methods We conducted three in‐depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. Findings No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. Conclusions  Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create.

• Publisher: Wiley,Wiley Subscription Services, Inc,Blackwell Publishing Ltd,John Wiley and Sons Inc
• Subject: Accountability / Asymmetric information / Asymmetry / Careers / Case depth / Case studies / contracting / Delivery of Health Care - economics / Delivery of Health Care - organization & administration / Electronic procurement / England / Health care / Health planning / Health services / health systems / Humans / Installation / Interorganizational relations / Interorganizational relationships / Markets / Netherlands / Organizational Case Studies / Original Scholarship / Patient satisfaction / Policy making / Political finance / Political power / Politics / Power, Psychological / Program Evaluation / Purchasing / Satisfaction / State Medicine - economics / State Medicine - organization & administration / strategic purchasing / United Kingdom / United States / Value-Based Purchasing - economics / Value-Based Purchasing - organization & administration