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Alternatives to fundholding

H Glennerster1, A Cohen, V Bovell

  • 1STICERD, London School of Economics, England.

International Journal of Health Services : Planning, Administration, Evaluation
|March 11, 1998
PubMed
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General practitioner (GP) fundholding is being abolished in the UK. This study compares "exit" strategies of fundholders with "voice" strategies of non-fundholders to understand effective health purchasing alternatives.

Area of Science:

  • Health policy and management
  • Primary care
  • Health economics

Background:

  • The UK's Labour government is reforming general practitioner (GP) fundholding.
  • Alternative GP-based purchasing schemes are being explored.
  • This study evaluates the effectiveness of different GP purchasing strategies.

Purpose of the Study:

  • To develop a theory predicting the success of 'exit' vs. 'voice' strategies in health purchasing.
  • To describe and evaluate alternative GP purchasing schemes.
  • To compare the success of fundholding and non-fundholding GPs in achieving objectives.

Main Methods:

  • Qualitative evaluation of alternative GP purchasing schemes in six districts.
  • Surveys of fundholding and non-fundholding GPs in four districts (eight practices each).

Related Experiment Videos

  • Analysis of purchasing intentions and outcomes across four specialties.

    • Main Results:

    • Fundholding GPs used direct purchasing power ('exit') to drive change.
    • Non-fundholding GPs developed 'voice' strategies to influence decisions.
    • Comparison of the relative success of fundholders and non-fundholders in achieving purchasing goals.

    Conclusions:

    • Both 'exit' and 'voice' strategies have conditions favoring their success in health purchasing.
    • Understanding these strategies is crucial for designing effective primary care reforms.
    • Alternative models to GP fundholding warrant further investigation and development.