title: How managed a market? Modes of commissioning in England and Germany.
abstract: BACKGROUND
  In quasi-markets governance over healthcare providers is mediated by commissioners. Different commissioners apply different combinations of six methods of control ('media of power') for exercising governance: managerial performance, negotiation, discursive control, incentives, competition and juridical control. This paper compares how English and German healthcare commissioners do so.
  
  
  METHODS
  Systematic comparison of observational national-level case studies in terms of six media of power, using data from multiple sources.
  
  
  RESULTS
  The comparison exposes and contrasts two basic generic modes of commissioning: 1. Surrogate planning (English NHS), in which a negotiated order involving micro-commissioning, provider competition, financial incentives and penalties are the dominant media of commissioner power over providers. 2. Case-mix commissioning (Germany), in which managerial performance, an 'episode based' negotiated order and juridical controls appear the dominant media of commissioner power.
  
  
  CONCLUSIONS
  Governments do not necessarily maximise commissioners' power over providers by implementing as many media of power as possible because these media interact, some complementing and others inhibiting each other. In particular, patient choice of provider inhibits commissioners' use of provider competition as a means of control.
authors.affiliation: University of Plymouth, UK. R.Sheaff@plymouth.ac.uk
authors.forename: Rod
authors.initials: R
authors.lastname: Sheaff
authors.forename: Naomi
authors.initials: N
authors.lastname: Chambers
authors.forename: Nigel
authors.initials: N
authors.lastname: Charles
authors.forename: Mark
authors.initials: M
authors.lastname: Exworthy
authors.forename: Ann
authors.initials: A
authors.lastname: Mahon
authors.forename: Richard
authors.initials: R
authors.lastname: Byng
authors.forename: Russell
authors.initials: R
authors.lastname: Mannion
mesh_terms: D005858:Germany; D018166:Health Care Reform; D019981:Health Care Sector / Q000191:economics / Q000458:organization & administration; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D009313:National Health Programs / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D006113:United Kingdom