Contracts, payment mechanisms and bargaining power: the case of Cordoba’s health care system

Abstract

Objectives: To analyze the market structure of healthcare services in the province of Cordoba for the period 2003-2008, considering socio-economic and local health conditions, institutional framework, history of most relevant actors, and behaviors acquired as a response to their combined strategies. Methods: Literature review, stakeholder analysis and field surveys of public and private providers at second and third level of care for the departments of the City of Córdoba, Calamuchita and Tercero Arriba. Results: Cordoba appears as a case of monopolistic competition, with few competitors, high presence of leading institutions and vertical product differentiation as the strategy chosen by the players. Conclusions: Infrastructure is the first criterion to define competition, followed by technology, for both indicators of perceived or actual quality of both patients and financiers.