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Getting Health Reform RightA Guide to Improving Performance and Equity$
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Marc Roberts, William Hsiao, Peter Berman, and Michael Reich

Print publication date: 2008

Print ISBN-13: 9780195371505

Published to Oxford Scholarship Online: September 2009

DOI: 10.1093/acprof:oso/9780195371505.001.0001

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(p.212) 10 Organization
Getting Health Reform Right

Marc J. Roberts

William Hsiao

Peter Berman

Michael R. Reich

Oxford University Press

This chapter considers how government can influence the organization of the health-care delivery system. It begins by defining the meaning of “an organization”—as a provider of health-care services—and that of “the organization of the system.” It then describes three kinds of interventions: changes in who-does-what, changes in incentives, and managerial changes, and discusses how they can improve overall performance. These interventions must work together; incentive changes like decentralization or contracting will not alter outcomes unless accompanied by changes at the managerial level. Similarly, the potential cost savings and clinical quality gains from changing scale and scope will only be realized if managers take advantage of their opportunities. Ultimately, the behavior of front-line workers and their managers has to be changed to produce real improvement.

Keywords:   health sector reform, health care reform, public health, health policy, health care delivery, organizational change

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