A Framework for Purchasing Health Care Labor

Health care labor is central to managing and delivering health services. Because recruitment and retention policies are key issues for purchasers, gaining insights into labor-purchasing mechanisms may permit them to be addressed more effectively. This paper is intended to provide a brief introduction to health care labor purchasing and the mechanisms through which it can have an impact on the delivery of health services and on health system performance. A framework is developed to foster understanding of health labor purchasing mechanisms. This framework examines the different types and characteristics of the purchasers and providers. It also examines the terms of labor purchasing, that is, working conditions (career development, contract duration, working time and shift work, work autonomy and separation), remuneration and benefits. These elements determine, to a large extent, workers' behavioral responses such as willingness to apply for and accept employment and job satisfaction. In turn, these behavioral responses are likely to affect performance. Finally, contextual and policy factors related to the health care system and the labor market that affect labor purchasing, health services delivery, and health system performance, are also considered in the framework. Under this category, we review the public-private mix, the purchaser-provider split, contracting in and out, purchaser power, and provider power. The framework presented in this paper encompasses a wide diversity of elements, but the role of yet more factors should also be investigated. For instance, the role of cultural or political factors is likely to affect labor purchasing. The effects of migration on labor purchasing should also be considered. A better understanding of the interaction between the elements of the framework would reinforce the analysis.

Bibliographic Details

Main Authors:	Zurn, Pascal, Adams, Orvill
Language:	English en_US
Published:	World Bank, Washington, DC 2004-09
Subjects:	BASIC HEALTH, BASIC HEALTH SERVICES, BUDGET CONSTRAINTS, CAPITATION, CAPITATION SYSTEM, CITIES, COMPETITIVE MARKETS, DETERMINANTS OF HEALTH, DISEASE PREVENTION, DOCTORS, ECONOMICS OF HEALTH, EMPLOYMENT, FEE FOR SERVICE, FINANCIAL RISK, GENERAL PRACTICE, GENERAL PRACTITIONERS, HEALTH, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE FINANCING, HEALTH CARE PLANNING, HEALTH CARE PROVIDERS, HEALTH CARE REFORM, HEALTH CARE REFORMS, HEALTH CARE SECTOR, HEALTH CARE SYSTEMS, HEALTH CARE WORKERS, HEALTH DEVELOPMENT, HEALTH ECONOMICS, HEALTH EXPENDITURES, HEALTH FINANCING, HEALTH INSTITUTIONS, HEALTH INSURANCE, HEALTH OUTCOMES, HEALTH PROFESSIONALS, HEALTH PROMOTION, HEALTH PROVIDERS, HEALTH REFORM, HEALTH SECTOR, HEALTH SECTOR WORKERS, HEALTH SERVICE PROVIDERS, HEALTH SERVICE PROVISION, HEALTH SERVICES, HEALTH SERVICES ORGANIZATION, HEALTH SYSTEM, HEALTH SYSTEM PERFORMANCE, HEALTH SYSTEMS, HEALTH WORKFORCE, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, INCOME, INDUCED DEMAND, INNOVATION, INTERNATIONAL COMPARISONS, INTERVENTION, LABOR FORCE, LESSONS LEARNED, MANAGERS, MARKET FAILURES, MEDICAL CARE, MEDICAL EQUIPMENT, MEDICAL SAVINGS ACCOUNTS, MEDICARE, MIGRATION, MORTALITY, MOTIVATION, NONGOVERNMENTAL ORGANIZATIONS, NONPROFIT SECTOR, NURSES, NURSING, NURSING CARE, NUTRITION, PATIENT SATISFACTION, PATIENTS, PHARMACISTS, PHYSICIANS, POLICY, POLICY RESEARCH, PRIMARY CARE, PRIMARY HEALTH CARE, PRIVATE INSURANCE, PRIVATE SECTOR, PROFESSIONAL ASSOCIATIONS, PROMOTING HEALTH, PUBLIC HEALTH, PUBLIC HEALTH CARE, PUBLIC HEALTH INTERVENTIONS, PUBLIC HEALTH SYSTEMS, PUBLIC HEALTH WORKERS, PUBLIC HOSPITALS, PUBLIC SECTOR, QUALITY OF CARE, SERVICE DELIVERY, SOCIAL POLICY, VACCINATION, WORKING CONDITIONS,
Online Access:	http://documents.worldbank.org/curated/en/2004/09/5643425/framework-purchasing-health-care-labor https://hdl.handle.net/10986/13754
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