Use of contracting in public health.

Over the last ten years, an increasing number of countries, both developed and developing, have turned to cont tracting, the subject of the theme issue of the Bulletin, as a means of improving the performance of their health syst tems. Contracting is increasingly used as a tool to manage the relationships between the different types of actors in the health sector. It uses the logic of the marketplace to improve performance but still respects the facts that health has many characteristics of a public good and the government must be the overall steward of the health sector. Contracting today is used in widely differing situations and contexts. The first article in the Policy and Practice section of this theme issue of the Bull letin, by Jean Perrot (pp. 859–866), presents a typology, based on the object or focus of the contract, that allows the overall logic of contracting to be clearly seen despite the diversity in the way it has been implemented. Perrot illust trates the main types of contracts with examples taken from a wide geographit cal horizon. Considerable experience with different types of contracting has now been accumulated, and several articles have appeared in recent years in the academic literature. This special issue of the Bulletin seeks to add to this knowledge, aimed particularly at count try decisiontmakers, by including four articles that take partially a geographical perspective but also focus on different areas in which contracting has been used, as discussed below. For example, the article by Sameen Siddiqi et al. (pp. 867–875) shows the benefits as well as some of the problems that have emerged from contractt ing out selected functions of health systems in selected countries of the Eastern Mediterranean Region. Knut Lönnroth et al. (pp.876–883) then show how contracting has been used to encourage private sector providers