Traduction en français : Une évaluation de l'efficacité du système de soins communautaires suite aux réformes au Royaume Uni.
This paper reviews the ideas of public choice theory that provided the rationale for introducing the purchaser/provider split and suggests that the notion of provider self-interest is as undifferentiated a concept as its rival : public ethos or duty.
Using data from 18 months'observation and interviewing in five local authorities, it then goes on to address the huge amount of work involved in separating purchasing from providing.
We trace the changing understanding of the purpose of the split, problems of defining who is purchaser and who a provider, problems of working the new relationship between purchasers and providers, and difficulties in developing the purchasing function.
We then seek to examine what are believed to be the main benefits of the purchaser/provider split, asking whether there is evidence that purchasers are doing a better job of identifying needs than providers, and whether there is evidence of competition involving multiple providers and multiple suppliers.
Finally, we investigate whether there has been an increase in responsiveness, taking home care as an example.
The paper concludes that while increased competition among suppliers has been one important factor in two authorities in securing a more responsive service, the evidence is equivocal as to whether the purchaser/provider split has been the key to securing competition.
Mots-clés Pascal : Evaluation, Efficacité, Marché, Royaume Uni
Mots-clés Pascal anglais : Evaluation, Efficiency, Markets, United Kingdom
Notice produite par :
ENSP - Ecole nationale de la santé publique (devenue EHESP)
Cote : 96/03 V
Code Inist : 002B30A03B. Création : 28/06/1996.