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Can contracts drive clinical care?

A Hopkins1, J K Solomon

  • 1Research Unit, Royal College of Physicians, London.

BMJ (Clinical Research Ed.)
|August 24, 1996
PubMed
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Health service contracts are often unsuitable for improving clinical care quality. For chronic diseases and aging, implicit contracts based on trust between doctors and patients are more effective than process measures.

Area of Science:

  • Health Services Research
  • Medical Contract Law

Background:

  • Commissioners utilize contracts to procure health services from providers.
  • The NHS Executive places significant emphasis on contracting mechanisms within healthcare.
  • Contracts are theoretically designed to influence healthcare service quality.

Purpose of the Study:

  • To evaluate the effectiveness of healthcare contracts in driving clinical care quality.
  • To explore alternative mechanisms for influencing care in chronic disease management and aging populations.

Main Methods:

  • Analysis of the role of contracts in healthcare procurement.
  • Examination of the limitations of contractual frameworks in clinical practice.
  • Assessment of implicit trust-based relationships in healthcare delivery.

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Main Results:

  • Contracts are frequently inadequate for directly influencing clinical care quality.
  • Clinical activities, particularly for chronic diseases and aging, often rely on implicit agreements.
  • Mutual trust between physicians and patients is a key component of care within budgetary limits.

Conclusions:

  • Healthcare contracts are not always appropriate for improving clinical care.
  • Implicit contracts built on trust are crucial for managing chronic conditions and the effects of aging.
  • Rethinking contractual approaches may be necessary to better support clinical practice.