The purchaser/provider split for healthcare was introduced early in the 1990’s, tied into the ideas around greater efficiency through competition between providers in some kind of market; good providers would thrive and bad ones would fail and be replaced. The split had an additional implication, it made performance management and policy development easier. It was relatively easy to set targets for providers and then manage their performance against them; although difficult to do the same with commissioners. Commissioning has replaced purchasing but all the many efforts to make it work appear on the evidence to have failed. The costs have [...]
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