Health financing

Strategic purchasing for universal health coverage: key policy issues and questions

A summary from expert and practitioners’ discussions

Inke Mathauer, Elina Dale, Bruno Meessen

Publication details

Editors: World Health Organization
Number of pages: 23
Publication date: 2017
Languages: English, French
ISBN: 9789241513319
WHO reference number: WHO/HIS/HGF/Health Financing Working Paper/17.8


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Strategic purchasing is one of the main principles guiding health financing reforms to accelerate progress towards universal health coverage. Seeking to align funding and incentives with promised health services, active or strategic purchasing involves linking the transfer of funds to providers, at least in part, to information on aspects of their performance or the health needs of the population they serve. The objectives of strategic purchasing are to enhance equity in the distribution of resources, increase efficiency, manage expenditure growth and promote quality in health service delivery. It also serves to enhance transparency and accountability of providers and purchasers to the population.

The document outlines and frames five key policy issues that emerged from expert and practitioners’ discussions held at various meetings. These issues are considered critical for reforms to shift towards strategic purchasing and cover: 1) governance; 2) information management systems; 3) benefit design; 4) mixed provider payment systems; and 5) managing alignment and dynamics.

The issues point to the need for capacity strengthening and future research as identified in discussions with country policy-makers and development partners. The discussions also emphasized the importance of information management systems as a critical backbone for strategic purchasing as well as on governance as an overarching and cross-cutting function in order to align strategic purchasing reforms with other health financing reforms.

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