Contracting for quality: does length matter?
OBJECTIVE
To examine whether longer-term contracts for health services will shift attention away from concern for finance and activity levels and towards the achievement of better quality services.


METHODS
Analysis of 288 contracts from the British National Health Service (NHS) and 12 semi-structured interviews with staff from provider (NHS hospital trusts) and purchaser (health authorities) organisations.


RESULTS
No relationship was found between the duration of a contract and the duration of service specifications or quality frameworks. The annual contracting cycle is concerned largely with ensuring that all parties stay within activity targets and financial constraints, and this is unlikely to be affected by a shift to longer-term contracts. The setting of standards and initiatives to improve quality is largely independent of the contracting process and the duration of contracts, and relies on relationships rather than contracts.


CONCLUSIONS
It is optimistic to expect longer-term contracts automatically to produce a greater focus on quality and the incentives needed to ensure that improvements in quality are delivered. However, this may not matter as issues of quality are being addressed more appropriately in the British NHS through a variety of other routes.
Goddard
M
M
Centre for Health Economics, University of York, UK.
Ferguson
B
B
Dawson
D
D
D003284:Contract Services; D006801:Humans; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D013222:State Medicine / Q000458:organization & administration / Q000592:standards*; D013997:Time Factors; D006113:United Kingdom