although there is widespread recognition of the benefits of moving towards more flexible contractual arrangements and payment based on performance collective agreements have prevented modernisation of the incentive system although there is a fair amount of variation in approaches depending on national context a common feature across these national experiences has been the gradual implementation of the purchaserprovider split in the system as opposed to a bigbang strategy generally with positive results for the health system internally within each ss institute the purchaserside should demand increasing refined information on activities costs and outcomes from the providerside