TU, Germany
The term commissioning can be applied to both: commissioning an HTA report or commissioning services.
In the first sense it is related to the process of HTA. In Europe there are HTA agencies that have a so called general mandate which allows them to identify priorities and conduct assessments own their own initiative. However many HTA agencies in Europe perform assessments in the context of a formalised decision-making process in which an institution may (or should, or must) commissions the agency with the assessment of a relevant topic to inform a specific deliberative process. The commissioning institution assigns the HTA agency with the task of assessing an specific topic.
The second sense – commissioning services – is more closely related to the term purchasing. These terms can be best understood in a model of health system in which there is an institutional separation between the health services and the institution ultimately responsible for the health of a population (i.e. community). In such a model, the providers of primary health care, hospitals, rehabilitation services etc. represent in a way the means by which the institution accountable for health care (i.e. the local health authority, the regional government, etc. depending on the organisation and on the degree of decentralisation of the system) tries to achieve its ultimate goal: the production of population health. For example a regional health authority is responsible for the health of the population living within its administrative borders and has to reach agreements for service delivery with providers in order address the health needs of its population as well as guaranteeing equal access. Commissioning can thus be understood as the action of assigning tasks to providers. In addition, the term purchasing implies a money flow between the commissioning institution and the provider of health services, i.e. an amount of money is allocated to the provider in relation to the task assigned. Purchasing usually implies a greater degree of separation between both actors.
Planning refers more to the action of elucidating the health needs of a given population and allocating resources in order to meet them. In a model of separation between provider and purchaser/commissioner planning can be considered to be the necessary step previous to commissioning and/or purchasing.
The three terms are closely interrelated and it may be difficult to draw a clear conceptual border between them when there is no clear separation of roles (provider, purchaser, etc.) in the health system. Thus in some situations they may be used interchangeably.