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Long-Term Care Reforms in OECD Countries$
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Cristiano Gori, Jose-Luis Fernandez, and Raphael Wittenberg

Print publication date: 2015

Print ISBN-13: 9781447305057

Published to Policy Press Scholarship Online: January 2017

DOI: 10.1332/policypress/9781447305057.001.0001

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Commissioning long-term care services

Commissioning long-term care services

Chapter:
(p.117) Six Commissioning long-term care services
Source:
Long-Term Care Reforms in OECD Countries
Author(s):

Joanna Marczak

Gerald Wistow

Publisher:
Policy Press
DOI:10.1332/policypress/9781447305057.003.0006

Commissioning plays a vital role in improving the efficiency of long-term care (LTC) systems as it can ensure an appropriate expenditure of public budgets. This chapter reviews changes in the arrangements for commissioning services in recent years and explores the consequences of these changes for the system. The attempts to reform LTC systems in industrialised countries have relied on a number of market mechanisms such as outsourcing of services, purchaser-provider split and a greater consumer choice for service users. It has been a working assumption of policy makers that these mechanisms will deliver a combination of improved quality of care and cost-efficiency, although countries vary in the degree of implementation of these instruments. The chapter thus explores different commissioning models in respect of: purchaser-provider structures; the extent of outsourcing; the use of tendering and contracts and the degree of user-involvement in the commissioning process. It also reviews the evidence about changes in the prices of services and the quality of care following marketization, it discusses the balance between the provision of home care and residential care in recent years and it considers the nature and extent of transaction costs associated with marketization.

Keywords:   long term care, commissioning, purchaser-provider split, marketization in ltc, outsourcing, vouchers, user led commissioning, consumer choice in ltc, transaction costs

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