on the provider side the process of augmenting local autonomy would need to be undertaken in incremental steps and will depend on robust performance management it could start with transformation of selected hospitals into prospectivelyfunded organisations where managers are given some autonomy for daytoday decisions say mainly financial management under agreed performance targets monitored by the payer repss for instance this system could evolve later towards a model of corporatised organisations with greater autonomy but where hospitals keep their public status similar to the foundation trusts created in the united kingdom or public hospitals operating as stateowned enterprises in other health systems