Introducing Purchaser/Provider Separation in the Catalan Health Administration: A Budget Analysis

This article examines the extent to which the Catalan reform launched in 1990 effectively introduced the purchaser/provider separation within the public health administration. The reform had two formulation sources: a law passed by the Catalan Parliament, which left this principle vague, and a further 'new public management' discourse, which interpreted the law in terms of a clear purchaser/provider separation. This study uses Dunleavy's (1991) analytical model of agency types to compare the impact of the reform on the budget structures of the health administration agencies affected — namely, the Department of Health and Social Security, the Catalan Health Service and the Catalan Health Institute. The data show that while the provider role was clearly defined and implemented, the purchaser role was not. Instead, the role of the health authority embodied the complex blend of functions established by the text of the law, which was also reflected in its budget structure, and which blurred the separation between purchaser and provider.