Does budget-holding have a long-term effect on expenditure, staff and patients?

Does budget-holding have a long-term effect on expenditure, staff and patients? Kupat Holim Clalit (KHC), Israel's largest sick fund, initiated a unique demonstration program to transform primary care clinics into autonomous budget-holding units. The program was accompanied by an evaluation study that examined the influence of the program on clinic staff, level of expenditure, quality of service and patient satisfaction. Few studies have empirically examined the influence of a budget-holding program in relation to such a wide range of expected outcomes. A longitudinal study was conducted from 1991 to 1994 employing two methodologies: (a) a controlled case study of one experimental and one control clinic and (b) monitoring of all nine budget-holding clinics over time, compared to other clinics in the district. Multiple research tools were used: staff surveys, patient surveys, in-depth interviews, and analysis of financial data. The findings indicate that the budget-holding program has the potential to achieve cost containment without injuring staff morale, the service to patients or patient satisfaction. However, the KHC program did not lead to the expected improvement in staff motivation and attitudes, clinic services and clinic responsiveness to patients' needs. Implications for the literature on organization and management and for organizations considering the implementation of budget-holding programs are discussed. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Health Policy Elsevier

Does budget-holding have a long-term effect on expenditure, staff and patients?

Health Policy, Volume 40 (1) – Apr 1, 1997

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Publisher
Elsevier
Copyright
Copyright © 1997 Elsevier Ltd
ISSN
0168-8510
D.O.I.
10.1016/S0168-8510(96)00885-8
Publisher site
See Article on Publisher Site

Abstract

Kupat Holim Clalit (KHC), Israel's largest sick fund, initiated a unique demonstration program to transform primary care clinics into autonomous budget-holding units. The program was accompanied by an evaluation study that examined the influence of the program on clinic staff, level of expenditure, quality of service and patient satisfaction. Few studies have empirically examined the influence of a budget-holding program in relation to such a wide range of expected outcomes. A longitudinal study was conducted from 1991 to 1994 employing two methodologies: (a) a controlled case study of one experimental and one control clinic and (b) monitoring of all nine budget-holding clinics over time, compared to other clinics in the district. Multiple research tools were used: staff surveys, patient surveys, in-depth interviews, and analysis of financial data. The findings indicate that the budget-holding program has the potential to achieve cost containment without injuring staff morale, the service to patients or patient satisfaction. However, the KHC program did not lead to the expected improvement in staff motivation and attitudes, clinic services and clinic responsiveness to patients' needs. Implications for the literature on organization and management and for organizations considering the implementation of budget-holding programs are discussed.

Journal

Health PolicyElsevier

Published: Apr 1, 1997

References

  • The reluctant managers: clinicians and budgets in the NHS
    Pollitt, C.; Harrison, S.; Hunter, D.; Marnoch, G.
  • The influence of budget-holding on cost containment and work procedures in primary care clinics
    Gross, R.; Nirel, N.; Boussidan, S.; Zmora, I.; Elhayany, A.; Regev, S.

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