Levelling the playing field: The influence of municipal commissioning on care services in the social support act

Abstract

Background: In 2015 the procurement of services in the social support act became the responsibility of the Dutch municipalities. New mechanisms were introduced, like client level competition and, dialogue in the procurement. The influence of these mechanisms on the number and size of suppliers, contract duration, client satisfaction and how these are interrelated is researched. Methods: Quantitative data from all municipalities (n = 253) is used and data from ten specific municipalities (n= 10). First, the larger sample is analysed using quantitative methods followed by cluster analysis for the ten specific municipalities. Results: The results show that client satisfaction increased between 2020 and 2017. Next, dialogue-based procurement leads to longer contracts and higher client satisfaction and the number of suppliers has increased while their size has decreased. The cluster analysis indicates that this effect is strongest in smaller municipalities with shorter contract duration. In the larger municipalities, only the number of suppliers grew. Discussion: The results and literature show that a dialogue-based method leads to longer contracts and better quality of care. The client satisfaction increased between 2017 and 2020. This was unexpected but, larger municipalities had a higher score than smaller ones, which is in line with the literature. Finally, client level competition caused a large increase in the number of suppliers and a decrease in size which is also related to the size of the municipality and contract duration. Conclusions: If municipalities take the size of their municipality into account and work together with suppliers this leads to longer contract duration and higher client satisfaction. The shift in the number and size of the suppliers also shows the opportunities municipalities have to control the supply of services. This could have an impact on the quality of care and administrative load for municipalities.