Many disruptive factors can affect the effects of outsourcing. These include, but are not limited to, (i) opportunities for fraud and corruption during tendering and contract management processes (Greve, 2001; Belongs to 2011); (ii) the award of contracts may be more costly than the provision of the same service by the government due to the high transaction costs between the government and PNG (Bel 2007); (iii) Mistrust may develop in the contractual relationship between PNG, the Government, or both (Batley, 2006; Scope 2014; Van Slyke, 2007); and (iv) Governments may not be able to enforce treaties (England, 2004). It is argued that when contracting is in response to inefficient government service delivery, the same governments are often unable to effectively manage the contract, thereby achieving the objective of improving service delivery by a PNG (Bustreo 2003; Mills, 1998a). We found no other systematic reviews with which we could compare the results of our review. Table 3 described the case studies we identified during our research to provide additional information on the examples in which outsourcing was implemented. This information may include relevant details to understand the feasibility of implementing this approach in different environments. The case studies indicated that contracting can improve some aspects of the delivery and utilization of health care services, similar to the results of our review. Examples from the case studies are studies in which the awarding of contracts has been associated with an increase in the use of curative services (Alonge 2014; Ameli 2008; Arur 2010), as well as in the number of services provided by healthcare facilities (Heard 2013) and studies associated with fewer treatment errors in healthcare facilities (Shet 2011). This evidence should be considered in the context in which it is reported, with the understanding that the case studies have inherent biases due to a lack of controls or structured methods for the design or implementation of the subcontracting intervention. Outsourcing government health services is a funding strategy that governs how public sector funds are used to deliver services by non-governmental health care providers (NHPs). It is a contract between the government and a PNG that lists the mechanisms and conditions under which the PNG should provide health care on behalf of the government. Contracting Out aims to improve the provision and use of health services. This review updates a Cochrane Review first published in 2009.
One contract template to another template. YES NO The unit of analysis consisted of populations that access government clinical health services that are outsourced to non-government providers, whether for-profit or not-for-profit. Participants included users and non-users of these services, as well as health care facilities at all levels where these contracted services are provided. Since the intervention is directly linked to and influenced by a country`s economic and political conditions, we assumed that the results would not be transferable between LMICs and high-income countries. We therefore limited the review to LMICs as defined by the World Bank (World Bank 2016), using its classification of countries in low-income, lower-middle-income, and middle-income economies. We created a ”Summary of Outcomes” table for the comparison of key interventions and included the seven key endpoints, based on the review team`s assessment of the results, that are most likely to influence (i) decision makers` decision on contract implementation and (ii) the use of these contract services by patients and the general public. The seven outcomes are childhood immunization, antenatal visits, contraceptive use by women, under-one mortality, diarrhoea in children under five, equity in the use of clinical health services, and individual health expenditures (Table 1). Two review authors independently assessed the overall certainty of the evidence (high, moderate, low and very low) using the five GRADE considerations (risk of bias, effect consistency, inaccuracy, indirectness and publication bias) to reduce safety, and three factors to improve safety (large effect size, confounding factor, dose-response relationship) (Guyatt 2008). We used methods and recommendations as described in Chapter 11 of the Cochrane Handbook for Systematic Reviews of Interventions (Schünemann 2011), as well as EPOC worksheets (EPOC 2017c). We justified decisions to downgrade or improve grades with footnotes in the table and provided feedback to make it easier for readers to understand the note as needed. We used plain language statements to report these results in the review (EPOC 2017d). For the results presented in Table 1, we presented the evidence profile in Appendix 3 and for all other endpoints in Appendix 4.
The 2009 review identified the following criteria: ”For this review, the control group had to be for both RCTs and health care facilities or health facilities where the delivery of health services was carried out by the public using a traditional management mode, i.e. without the possibility for lower-level health managers to define the compensation levels of their employees” (Lagarde 2009, p. . . .