Public Ends, Private Means

Great progress has been made in recent years in securing better access and financial protection against the cost of illness through collective financing of health care. Managing scarce resources effectively and efficiently is an important part of this story. Experience has shown that, without strategic policies and focused spending, the poor are likely to get left out. The use of purchasing to enhance public sector performance is well-documented in other sectors. Extension to the health sector of lessons from this experience is now successfully implemented in many developing countries. 'Public Ends, Private Means: Strategic Purchasing of Value for Money in Health Services' is part of a series of World Bank publications on ways to make public spending on health care more efficient and equitable in developing countries. It reviews the underlying economics in terms of agency theory, behavioral science, contract theory, transaction costs, and public choice theory. It provides a synthesis of the institutional environment needed for countries to shift to strategic purchasing, organizational incentives that need to be in place, and management capacity that needs to be strengthened. The volume is supplemented with a CD that presents six regional reviews of current resource allocation and purchasing (RAP) arrangements.