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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

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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.