After considering the fulfillment ofsome basic criteria making purchasing a tool foreffectiveness, a framework allows to review how to best buyhospital services. Who should benefit most from hospitalcare financing ? The answer to this question will rely on aninvestigation of hospital services utilization, and on abetter understanding of patients profiles. This type ofinvestigation is a baseline for further decisions on what tobuy. A purchaser should wonder: to what public healthpriorities hospital responds best and how efficient andequitable is hospital care? But hospitals have also a uniquerole in helping people facing major hazards, in providingsome essential public health services and in enablingtraining: these services should be considered whenpurchasing. Hospitals represent a large diversity oforganizations. Having that in mind makes it easier to figureout from whom to buy. The potential provision of caredepends on the level of the provider but is also related tohospitals status taking into consideration productivity. Itis also worthwhile to investigate insurance's role inthe provision of care. Payment mechanisms have a stronginfluence on performance, for that reason the majoralternative schemes have to be considered, each of themhaving advantages and limits. But hospital cash flow is alsoa specific issue that should not be ignored. The price paidhas to be determined before making an agreement. This shouldlead to cautious estimates of cost of services as theinformation systems are often weak. Moreover it might beworthwhile to play with margin to favor internal crosssubsidies. The co-payments as well as the opportunity costhave to be included to understand how to get best frompricing. Dealing with subsidies is a cornerstone whenseeking better performance while purchasing hospitalservices. How subsidies are going to be channeled and forwhat kind of services will determine if purchasing is really effective.
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