title: A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy.
abstract: The aim of this systematic review was to assess evidence of the impact of commissioning on health service use, quality, outcomes and value for money and to consider findings in the Australian context. Systematic searches of the literature identified 444 papers and, after exclusions, 36 were subject to full review. The commissioning cycle (planning, contracting, monitoring) formed a framework for analysis and impacts were assessed at individual, subpopulation and population levels. Little evidence of the effectiveness of commissioning at any level was available and observed impacts were highly context-dependent. There was insufficient evidence to identify a preferred model. Lack of skills and capacity were cited as major barriers to the implementation of commissioning. Successful commissioning requires a clear policy framework of national and regional priorities that define agreed targets for commissioning agencies. Engagement of consumers and providers, especially physicians, was considered to be critically important but is time consuming and has proven difficult to sustain. Adequate information on the cost, volume and quality of healthcare services is critically important for setting priorities, and for contracting and monitoring performance. Lack of information resulted in serious problems. High-quality nationally standardised performance measures and data requirements need to be built into contracts and ongoing monitoring and evaluation. In Australia, there is significant work to be done in areas of policy and governance, funding systems and incentives, patient enrolment or registration, information systems, individual and organisational capacity, community engagement and experience in commissioning.
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Gardner
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: G Powell
authors.initials: GP
authors.lastname: Davies
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Edwards
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: McDonald
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Terry
authors.initials: T
authors.lastname: Findlay
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Rachael
authors.initials: R
authors.lastname: Kearns
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Chandni
authors.initials: C
authors.lastname: Joshi
authors.affiliation: Centre for Primary Health Care and Equity, 3rd Floor AGSM Building, University of New South Wales, NSW 2052, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Harris
mesh_terms: D001315:Australia; D003284:Contract Services; D003659:Decision Making, Organizational; D018166:Health Care Reform / Q000458:organization & administration*; D019981:Health Care Sector / Q000458:organization & administration*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D017146:Models, Organizational; D015279:Organizational Culture; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care