Q3.

Please explain the reasons for implementing strategic purchasing in healthcare and
describe at least 3 key strategic purchasing actions in relation to the following:
1) Providers,
2) Citizens or Population served, and
3) Government to promote strategic purchasing.
Purchasing refers to how institutions controlling pooled funds – like ministries of health and
health insurance agencies – allocate them to healthcare providers
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.
Three broad principles guide health financing reforms to accelerate progress towards
universal health coverage (UHC). The first is to move towards a predominant reliance on
compulsory (i.e. public) funding sources.
The second is to reduce fragmentation in pooling to enhance the redistributional capacity of
these prepaid funds.
The third, and the focus of this document, is to move towards strategic purchasing, which
seeks to align funding and incentives with promised health services
“Raising sufficient money for health is imperative, but just having the money will not ensure
universal coverage. Nor will removing financial barriers to access through prepayment and
pooling. The final requirement is to ensure resources are used efficiently.”
1. Key strategic purchasing actions in relation to providers
• Select (accredit) providers considering the range and quality of services, and their
location
• Establish service agreements/contracts
• Develop formularies (of generic drugs, surgical supplies, prostheses etc.) and
standard treatment guidelines
• Design, implement and modify provider payment methods to encourage efficiency
and service quality
• Establish provider payment rates
• Secure information on services provided
• Monitor provider performance and act on poor performance
• Audit provider claims
• Protect against fraud and corruption
• Pay providers regularly
• Allocate resources equitably across areas
• Implement other strategies to promote equitable access to services
• Establish and monitor user payment policies
• Develop, manage and use information systems

2. Key strategic purchasing actions in relation to citizens or population served

• Assess the service needs, preferences and values of the population and use to specify
service entitlements/benefits
• Inform the population of their entitlements and obligations
• Ensure population can access their entitlements
• Establish effective mechanisms to receive and respond to complaints and feedback
from the population
• Publicly report on use of resources and other measures of performance

3. Key strategic purchasing actions by government to promote strategic purchasing

• Establish clear frameworks for purchaser(s) and providers
• Fill service delivery infrastructure gaps
• Ensure adequate resources mobilised to meet service entitlements
• Ensure accountability of purchaser(s)

QN 2
Please describe the Definition and Concept of Universal Health Coverage and
draw the UHC cubic with 3 main concepts
UHC means that all individuals and communities receive the health services they need
without suffering financial hardship. It includes the full spectrum of essential, quality health
services, from health promotion to prevention, treatment, rehabilitation, and palliative care
across the life course.

The three dimensions of UHC (population coverage, package of services provided and level of
financial protection) are often represented through the UHC cube
The X axis is the population coverage,
the Y axis is the cost coverage measured by level of out-of-pocket cost sharing by members,
and the Z axis is the service coverage, how comprehensive the benefit package would cover?
There are also trade-offs between these three dimensions such as should the country cover
more services to certain groups, or same service for the whole population

The X axis is the population

coverage, the Y axis is the cost
coverage measured by level
of out of pocket cost sharing by
members, and the Z axis is
the service coverage, how
comprehensive the benefit package
would cover? There are also trade-
offs between these three
dimensions such as should the
country cover more services
to certain groups, or same service for
the whole population
QN 3Please explain the Sustainable Development Goals (SDGs) and SDG 3

The Sustainable Development Goals (SDGs), also known as the

Global Goals, were adopted by the United Nations in 2015 as a
universal call to action to end poverty, protect the planet, and
ensure that by 2030 all people enjoy peace and prosperity.
The 17 SDGs are integrated—they recognize that action in one
area will affect outcomes in others, and that development must
balance social, economic and environmental sustainability

Goal 3

GOOD HEALTH AND WELL-BEING

Pros and Cons of two main payment structure (Prospective vs. Retrospective payment)
RETROSPECTIVE
PRONS CONS

allow patients to receive more some providers might try to game

individualized care. Since healthcare
providers are not limited to pre-
approved treatment rates, they can
deliver the exact services their
patient needs
the system by recommending
services that are more costly in order
to enhance their profit
Incentive to overspend
patients who may be subjected to
treatment they do not actually need

PROSPECTVIE

ADVANTAGES

 prospective payment plan have made calculating expenditures more

predictable.
 significant savings for many insurance companies

DISADV

 Prospective payment plans may also encourage health-care providers to

cut corners or employ other means to cut costs. These cost-cutting
measures do not account for quality of care for patients
 prospective payment plans provide an incentive for health-care
providers to treat a higher volume of patients to realize the greatest
possible revenue and profit margin.