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Quality check: does it matter for quality how you organise and pay for health care? A review of the international evidence

Lookup NU author(s): Dr Kayleigh Garthwaite, Professor Clare Bambra



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


Health systems in high-income countries have experienced significant organizational and financial reforms over the last 25 years. The implications of these changes for the effectiveness of health care systems need to be examined, particularly in relation to their effects on the quality of health services (a pertinent issue in the United Kingdom in light of the Francis Report). Systematic review methodology was used to locate and evaluate published systematic reviews of quantitative intervention studies (experimental and observational) on the effects of health system organizational and financial reforms (system financing, funding allocations, direct purchasing arrangements, organization of service provision, and service integration) on quality of care in high-income countries. Nineteen systematic reviews were identified. The evidence on the payment of providers and purchaser-provider splits was inconclusive. In contrast, there is some evidence that greater integration of services can benefit patients. There were no relevant studies located relating to funding allocation reforms or direct purchasing arrangements. The systematic review-level evidence base suggests that the privatization and marketization of health care systems does not improve quality, with most financial and organizational reforms having either inconclusive or negative effects.

Publication metadata

Author(s): Footman K, Garthwaite K, Bambra C, McKee M

Publication type: Article

Publication status: Published

Journal: International Journal of Health Services

Year: 2014

Volume: 44

Issue: 3

Pages: 479-505

Print publication date: 01/07/2014

Online publication date: 01/07/2014

Acceptance date: 01/01/2014

Date deposited: 05/02/2017

ISSN (print): 0020-7314

ISSN (electronic): 1541-4469

Publisher: Sage Publications, Inc.


DOI: 10.2190/HS.44.3.d


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