The 1997 Balanced Budget Act (BBA) permits private contracting for care between Medicare beneficiaries and providers who have opted out of Medicare. This article examines the number and characteristics of providers who have opted-out, their role in the provision of Part B services, and their impact on beneficiary access from 1998 to 2002. Opt-out providers differ from providers remaining in Med...

Despite the increased popularity of contracting-out of health services in developing countries, its effectiveness on overall health system performance is not yet conclusive. Except for substantial evidence of contracting-out's positive effect on access to health services and some evidence on improved equity in access, there is little evidence of contracting-out's impact on quality and efficienc...

Background In the attempt to move towards universal health coverage (UHC), many low- and middle-income countries (LMICs) are actively seeking to contract-out non-state providers (NSPs) to deliver health services to a specified population. Research on contracting-out has focused more on the impact of contracting-out than on the actual processes underlying the intervention and contextual factors ...

BACKGROUND The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan. METHOD...

Contracting-out has become increasingly prominent in the health-care sector. It has been used in activities ranging from 'internal market' arrangements in which providers compete for funding from government payers to purchases of medical and non-medical inputs by service providers. While contracting-out arrangements for non-medical services have been widely adopted with apparent success, the co...