The barriers to the application of strategic purchasing and the role of health policy- and decision-makers: past, current status, ethical aspects and future challenges
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Keywords

healthcare systems and organizations
contracting and strategic purchasing
healthcare services and provisions
scientific evidence
cost-effectiveness

Abstract

Healthcare systems are complex, multi-level, highly integrated organizations, comprising of different professional figures, institutions, and resources. Such breadth and complexity reflect the multi-dimensionality of the concept of health, which implies the adoption of a holistic approach. Health, rather than merely being the absence of disorders or infirmity, is a highly dynamic state, which represents the abilities of an individual to cope with adverse social, physical and emotional/psychological events and conditions, continuously adapting to them. Ensuring an adequate health state is one of the most important concerns, and the healthcare systems are called to renew themselves in order to meet with the new challenges and health needs. Throughout the last decades, due to demographic shifts and transitions, epidemiological and societal changes, technological achievements and scientific advancements, healthcare systems have undergone an extensive series of reform plans. Therefore, health policy- and decision-makers have made efforts to develop and implement initiatives for preserving the quality of the healthcare provisions. Strategic purchasing is an approach of purchasing that takes into account several health-related issues such as a proper, comprehensive planning of service delivery, the design and selection of the best packages of services and provisions, the appropriate selection of providers and the allocation of economical and financial incentives to provide better services and to motivate managers to adopt appropriate policies to implement strategic purchasing. Here, we intend to consider the various dimensions and aspects that can be effective in strategic purchasing, as well as the main barriers and obstacles that hinder its full implementation.

https://doi.org/10.15167/2421-4248/jpmh2020.61.1.1439
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References

1. Devadasan N, Seshadri T, Trivedi M, Criel B. Promoting universal financial protection: evidence from the Rashtriya Swasthya Bima Yojana (RSBY) in Gujarat, India. Health Res Policy Syst. 2013;11:29.
2. Etiaba E, Onwujekwe O, Honda A, Ibe O, Uzochukwu B, Hanson K. Strategic purchasing for universal health coverage: examining the purchaser-provider relationship within a social health insurance scheme in Nigeria. BMJ Glob Health. 2018;3(5):e000917.
3. Gorji HA, Mousavi SMSP, Shojaei A, Keshavarzi A, Zare H. The challenges of strategic purchasing of healthcare services in Iran health insurance organization: a qualitative study. Electron Physician. 2018;10(2):6299-306.
4. Habicht T, Habicht J, van Ginneken E. Strategic purchasing reform in Estonia: Reducing inequalities in access while improving care concentration and quality. Health Policy. 2015;119(8):1011-6.
5. Huber M, Knottnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011;343:d4163.
6. Ibe O, Honda A, Etiaba E, Ezumah N, Hanson K, Onwujekwe O. Do beneficiaries' views matter in healthcare purchasing decisions? Experiences from the Nigerian tax-funded health system and the formal sector social health insurance program of the National Health Insurance Scheme. Int J Equity Health. 2017;16(1):216.
7. Marten R, McIntyre D, Travassos C, Shishkin S, Longde W, Reddy S, et al. An assessment of progress towards universal health coverage in Brazil, Russia, India, China, and South Africa (BRICS). Lancet. 2014;384(9960):2164-71.
8. McIntyre D, Ranson MK, Aulakh BK, Honda A. Promoting universal financial protection: evidence from seven low- and middle-income countries on factors facilitating or hindering progress. Health Res Policy Syst. 2013;11:36.
9. Ogbuabor DC, Onwujekwe OE. Scaling-up strategic purchasing: analysis of health system governance imperatives for strategic purchasing in a free maternal and child healthcare programme in Enugu State, Nigeria. BMC Health Serv Res. 2018;18(1):245.
10. Sanderson J, Lonsdale C, Mannion M. What’s needed to develop strategic purchasing in healthcare? policy lessons from a realist review. Int J Health Policy Manag. 2019;8(1):4–17.
11. Braithwaite J, Testa L, Lamprell G, Herkes J, Ludlow K, McPherson E, et al. Built to last? The sustainability of health system improvements, interventions and change strategies: a study protocol for a systematic review. BMJ Open. 2017;7(11):e018568.
12. Liaropoulos L, Goranitis I. Health care financing and the sustainability of health systems. Int J Equity Health. 2015;14:80.
13. Han W. Health Care system reforms in developing countries. J Public Health Res. 2012;1(3):199–207.
14. Bentley TG, Effros RM, Palar K, Keeler EB. Waste in the U.S. Health care system: a conceptual framework. Milbank Q. 2008;86(4):629–59.
15. Klasa K, Greer SL, van Ginneken E. Strategic purchasing in practice: comparing ten European countries. Health Policy. 2018;122(5):457-72.
16. Patcharanarumol W, Panichkriangkrai W, Sommanuttaweechai A, Hanson K, Wanwong Y, Tangcharoensathien V. Strategic purchasing and health system efficiency: A comparison of two financing schemes in Thailand. PLoS One. 2018;13(4):e0195179.
17. World Health Organization. Health financing for universal coverage 2019 [Available from: https://www.who.int/health_financing/topics/purchasing/passive-to-strategic-purchasing/en/.
18. world Health Organization. The world health report 2000 - Health systems: improving performance. 2000.
19. Dehnavieh R, Jafari Sirizi M, Mehrolhassani MH, Kalantari A. Strategic purchasing of healthcare services in developing countries: a new approach is required. Iran J Public Health. 2016;45(9):1241-2.
20. Bigdeli M, Annear PL. Barriers to access and the purchasing function of health equity funds: lessons from Cambodia. Bull World Health Organ. 2009;87(7):560-4.
21. World Health Organization. Strategic purchasing for universal health coverage: key policy issues and questions,A summary from expert and practitioners’ discussions 2017 [Available from: https://www.who.int/health_financing/documents/strategic-purchasing-discussion-summary/en/.
22. Bastani P, Samadbeik M, Kazemifard Y. Components that affect the implementation of health services' strategic purchasing: a comprehensive review of the literature. Electron Physician. 2016;8(5):2333-9.
23. Ghoddoosi-Nejad D, Jannati A, Doshmangir L, Arab-Zozani M, Imani A. Stewardship as a fundamental challenge in strategic purchasing of health services: a case study of Iran. Value Health Reg Issues. 2018;18:54-8.
24. González-Block MÁ, Figueroa A, García-Téllez I, Alarcón J. [Financial allocations in the System for Social Protection in Health in Mexico: challenges for strategic purchasing]. Salud Publica Mex. 2016;58(5):522-32.
25. Kalantari AR, Jafari Sirizi M, Mehrolhassani MH, Dehnavieh R. Challenges of implementation: Strategic purchasing in Iran Health Insurance Organization. Int J Health Plann Manage. 2019;34(1):e875-e84.
26. Liu K, He AJ. Able to purchase? Agency problems in China's social health insurance system and the pitfalls of third-party strategic purchasing. Int J Health Plann Manage. 2018;33(4):1045-59.
27. Nejad DG, Janati A, Arab-Zozani M. The neglected role of stewardship in strategic purchasing of health services: who should buy? East Mediterr Health J. 2019;24(11):1038-9.
28. Pu X, Gu Y, Wang X. Provider payment to primary care physicians in China: background, challenges, and a reform framework. Prim Health Care Res Dev. 2018:1-7.
29. Langenbrunner JC, Hovig D, Cashin C. [Trends in health financing: the move from passive to strategic purchasing in middle- and low-income countries]. World Hosp Health Serv. 2016;52(4):12-9.