Rijtjes healthcare purchasing - lecture 6 + 7

Dimensions framework Kim (buyer-supplier relationship)

Relational intensity → arms-length - closely tied

Relational posture → adversarial - cooperative

4 types of relationships - framework Kim

Sticky (closely-tied, adversarial)

Deep (closely-tied, cooperative)

Transient (arms-length, adversarial)

Gracious (arms-length, cooperative)

Contract function + frame (Dohmen)

function = what the clause does

frame = how the clause is interpreted

Two functions of contracts

• control (rights and obligations)

• coordination (joint objectives, allocate responsibilities)

Two frames of contracts

• Prevention (targets defined as minimum thresholds)

• Promotion (performance targets as maximum achievements)

Orchestration logic (Noort)

Achieve chain-wide improvement, striving for better health outcomes and lower long-term costs

Bookkeeping logic (Noort)

Controlling short-term costs and focus on managing individual providers

Stakeholder pressures that explain shift between orchestration and bookkeeping logic

1. Relationship pressures (maintain relationships with different providers)

2. Cost pressured (manage healthcare expenditures)

3. Medical demands (healthcare system requires high-quality of care)

4. Public health demands (societal expectations that healthcare systems focus on good population health)

5. uncertainty (the unpredictable nature of healthcare environments may lead to a switch)

Goal new sales model UMCG

allocate revenues to organizational entities

• allocation per core task

• performance indicator per core task

• measuring performance

• allocate revenues per entity

Activity based budgeting (UMCG)

If activity changes the budget may also change