Professionalism & Performance-based Contracting

Professionalism & Performance-based Contracting
Rosanne Oomkens, i.c.w. prof. dr. Trudie Knijn

In many countries attempts have been made to shift their health care sector toward a market-oriented and managerial-based system, referred to as ‘New Public Management’. In the Netherlands this is reflected by the introduction of performance-based contracting: health insurers are now expected to transform from passive payers to prudent and critical purchasers of health care who evaluate care providers according to performance criteria. This research explores the relationship between performance-based contracting, as a New Public Management instrument, and professionalism in Dutch hospital care and home care.

            Currently, two streams are dominant within the debate on New Public Management and professionalism. In the first stream authors argue that the professional logic of peer control and professional’s emphasis on patient needs are ‘colonized’ by market and managerialist principles and that professional individual autonomy is therefore eroded and job satisfaction declines. In the second stream this so-called ‘de-professionalization’ thesis is challenged, claiming that it fails to take into account how deeply welfare state institutions have been colonized by professionals and arguing that modes of professional self-regulation remain dominant. The present research adds to this debate by showing that the relationship between performance-based contracting and professionals’ autonomy and intrinsic job satisfaction varies across professional groups. The way performance-based contracting is implemented, the mechanism that it triggers – ‘transparency’, ‘accountability’, ‘interference’ – and subsequently the consequences it has for professionals’ autonomy and intrinsic job satisfaction are dependent on the particular institutional position of professionals.  

            By interconnecting theories on institutionalism and theories on professionalism this study shows that using the concept of ‘degree of professionalism’ is an analytical tool for studying the institutional position of professions and therefore useful for our understanding of the evolution of health care governance systems and for understanding occupational and organizational changes due to policy changes.