Contracting and the purchaser-provider split in western Europe a legal-organizational analysis

Market forces have been introduced in the health care systems of many European countries. Fundamental to the introduction of the market was the need to distinguish between the roles of purchaser and provider. In this article the authors have analyzed the consequences of contracting and the purchaser-provider split from both a legal and organizational perspective. Using a modification of an existing theoretical framework for analyzing the basic health care models, contracting and the purchaser-provider split in some Western European countries has been analyzed. Including the legal and organizational dimension into these economically oriented models, these models can also be used for analyzing recent trends and developments. A four-country analysis indicates trends towards convergence of health care systems and both decentralization and integration in the systems. The future roles of both managers and lawyers working in health care need to be further defined.