A rapid review of the impact of commissioning on service use, quality, outcomes and value for money: implications for Australian policy

Abstract

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.

Commissioning and equity in primary care in Australia: Views from Primary Health Networks

“…Gardner et al. () in a review of literature noted that effective commissioning relies on a clear policy framework, engagement by service providers and consumers, and flexibility in responding to changing conditions. The political context in Australia is complicated by an additional layer of government which requires PHNs to negotiate different policy contexts.…”

“…Gardner et al. () noted that commissioning in Australian primary healthcare has traditionally been used to provide services to populations that have been underserved (e.g. rural and Aboriginal and Torres Strait Islander populations).…”

“…Commissioning is based on a separation of the purchaser from the provider of the services (Checkland, Harrison, Snow, McDermott, & Coleman, ). It is underpinned by an understanding that efficiencies and cost saving can be achieved through competition between service providers (Booth & Boxall, ; Gardner et al., ) and that priority setting will result in improved service integration and service delivery to at‐risk populations (Robinson, Dickinson, & Durrington, ).…”

“…Commissioning relies on three activities: strategic planning, contracting services and service evaluation (Gardner et al., ). Strategic planning involves making decisions about the health needs of a population, the services to be provided and capacity of providers to deliver that service (Checkland et al., ).…”

Systems levers for commissioning primary mental healthcare: a rapid review

“…Documents were classified according to their methods: qualitative, quantitative, mixed methods, review or position paper (categories adapted from Gardner et al 2016). One descriptor was allocated per document.…”