Abstract
Is it feasible to purchase quality care in psychiatry through managed competition? Can representatives of the Swedish public choose wisely between tenders for care and hold the provider accountable? Yes, to a point. The parties can reasonably agree on a budget to serve a defined population, using professional guidelines and procedures for diagnosis, treatment, and follow-up. Such an agreement is likely to enhance the quality of care. It can be audited partly by means of nonspecific multiple indicators. Nevertheless, paying for specific patient outcomes has the propensity to upset the care ecosystem, inviting bias and corruption. Comparative field studies of the impact of specific outcome indicators are recommended before the reform cycling continues.
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