Exploring the role for strategic purchasing instruments to support improvements in the quality of care

Overview

Quality health services are an intrinsic part of universal health coverage (UHC) and are embedded within its definition. UHC means that all people can access needed health services of sufficient quality without financial hardship. Health services – both individual as well as population-based interventions – need to be of sufficient quality to increase the likelihood that they will improve the health of those who use them. The provision of quality health services depends on many factors. Health care purchasing – i.e. the way these prepaid and pooled funds are allocated to providers for the health services they provide – plays a role in providing and improving quality health services.

This paper looks at how – and which – purchasing instruments can serve as levers to improve quality in service provision, with the focus here on personal health services. The paper is geared towards both health financing and purchasing policy makers and analysts as well as stakeholders involved in efforts to improve the quality of care.

The document outlines the range of purchasing arrangements relating to benefits design, provider selection, payment methods, information management systems, and governance arrangements that can contribute to this complex endeavor. Yet, these should not be considered in isolation. Purchasing arrangements should not be the dominant part of a strategic approach to improve quality and alone are by no means sufficient to improve quality. This must be carefully considered in design and implementation, particularly with respect to payment methods in order to avoid system distortion and negatively interfering with intrinsic motivation of health workers.