With a common history, countries formerly involved in centrally-planned economies have seen wide swings in policy between privatization and government-administered systems. Such projects exhibit similar challenges. Privatization can bring expertise to the picture, but also conflicts of interest that can result in expensive services that may even be misapplied. While government-administered services remove problems for direct conflicts of interest, they tip the balance between expertise and politics, resulting in a misapplication of resources, particularly where the underlying science and practice are complex and changing.

For this reason, Dr. Manicki and his colleagues concentrated their efforts on multiple-actor public-private partnerships with centralized national payment authorities. Such an arrangement allows for input from authoritative, policy-oriented actors as well as subject matter and practice experts. Indeed, without input from both sides, payment schemes cannot be derived that are both rational and fair.

The critical pathway of building adequate payment models must include “stakeholder management” where stakeholders are clearly defined and positioned in the context of health services purchasing. This is to give stakeholders the feeling of having control on the reforming process (commitment in purchasing). Commitment in purchasing becomes the fundamental prerequisite for maintaining quality in long term relationships among stakeholders, including reduction of tension among them, preserving appropriate quality of services, and keeping the cost of those services at an affordable level. It also gives space to coordinate purchasing tools with the needs of the population and allows for adjustments if something goes wrong.