2026/01/01 by S J Dorgan · 1 voice
Health Professions · Economics, Econometrics and Finance · #Primary Care and Health Outcomes #Healthcare Policy and Management #Healthcare Systems and Reforms
paper · doi:10.17037/pubs.04681554
openalex publication_date 2026/01/01 · openalex created_date 2026/04/02 · openalex updated_date 2026/07/01
Management practice has long been considered central to improving health system performance, quality, outcomes, and productivity. This thesis aims to deepen our understanding of the relationship between healthcare payor management practices, the performance of the local healthcare systems they manage, and the health outcomes of their managed populations. It attempts to do this for healthcare payors in England, using well-established analytical techniques and secondary data collated between 2008 and 2010. Specifically, this thesis exploits a unique, previously unexplored dataset capturing the assessed management practices of all 152 healthcare payors in England’s National Health Service, in both 2008 and 2010. This thesis has four key objectives. First, it describes a novel healthcare payor management practice assessment tool and evaluates that tool’s reliability and robustness as a means of measuring healthcare payor management practices. Second, it explores potential links between healthcare payor management practices, the performance of the health systems those payors manage, and the health outcomes of their managed populations. Third, it explores what returns, if any, in both health system performance and managed population health, are associated with healthcare payor improving their management practices over time. Finally, it explores mechanisms by which payor management practice might causally influence both health system performance and managed population health outcomes. This thesis finds that healthcare payor management practice is measurable and significantly associated with both health system performance and managed population health outcomes. In addition, it finds that improvements in the management practices of individual payors over time are associated with improvements in health system performance and managed population health. Also, it identifies that the influence of payor management practice upon population health appears to be mediated by the performance of the health system managed, and particularly the use of resources within that healthcare system. Finally, this thesis finds that improving healthcare payor management practice may be a neglected lever for health system and population health improvement. This thesis provides a foundation for further research to confirm the validity and generalisability of these findings