Free Essay: Strategic Purchasing for Universal Health Coverage

Getting more value for the money spent on health care is what strategic purchasing is all about. Countries and healthcare organizations can enhance the quality of services and care they provide by ensuring more people can access them and with limited funds. Strategic purchasing targets to build capacity in African countries and move regions closer to universal health coverage ("Moving from passive to strategic purchasing," 2018). The purchaser is the health insurance agency or individual that pays the provider for the services offered. The purchasers can be the ministry of health, a private insurance company, or a health insurance program. Strategic purchasing gives the purchasing power to the one paying for the services which means that one can make decisions regarding the services and medicines to buy as well as create incentives that would motivate providers to deliver high-quality care while ensuring the health system cost-effectively uses services.

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"Strategic purchasing for universal health coverage: key policy issues and questions" is a document entailing a synopsis from the deliberations of experts and practitioners that describes strategic purchasing as one central principle that guides health financing reforms. The authors Inke Mathauer, Elina Dale, and Bruno Meessen analyze and put together expert and practitioners' discussions on the issue of strategic purchasing in health. The brief provides an overview of how strategic purchasing can be used to guide health financial reforms and pick up the pace towards a universal health coverage (Mathauer, Dale & Meessen, 2017). Additionally, it examines the objectives and processes of strategic purchasing which involve the linking of funds transfer to providers and the ability to enhance equity when it comes to resource distribution, efficiency increment, and managing expenditure growth as well as the promotion of quality in the delivery of health services. The summary also finds that strategic purchasing enhances provider accountability and transparency to the population.

The short frames and examines the critical policy issues that were discussed by the expert and practitioners who met on various occasions. The topics discussed are the ones that were found to be vital for reforms that lead to strategic purchasing. The issues are found to be crucial for the improvements were governance, information management systems, provider payment systems, managing alignment and dynamics, and benefit design. What's more, the issues examined in the summary call for the need for the strengthening of capacity and future research. There is the emphasis of the information management systems as vital in support of strategic purchasing and on governance by acting as an all-inclusive and cross-cutting function that brings into line the strategic purchasing transformations with all the other health financing modifications.

This document contributes to the understanding of payment methodology by making strategic purchasing as one primary principle that guides health financial reforms. It shows that the health financing is intended to bring about universal coverage encouraging the health sector to move from passive purchasing to strategic purchasing ("Moving from passive to strategic purchasing," 2018). The evidence-based engagement selects the service-mix and provider-mix with the intent of maximizing societal objectives. By incorporating the Fee for Service, the managed care plans, and the Pay for Performance programs in health care, it improves the strategic purchasing of the health services which in the long run enhances the health system performance making it a step closer to the universal health coverage ("Fee-for-Service vs Managed Care Medicine", 2004). Besides, strategic purchasing requires the purchaser to have information on the services that should be delivered as a priority including the services that should be given priority concerning a range of variables like gender, age, and geographical distribution. Additionally, it contributes to the understanding of managed care plans by providing a priority primary health care which includes protective funding for the services and the payment of relatively high amounts for the primary health care services.

According to the document, managed care plans involve the use of incentives to link payment to performance and limit the provision of costly services by paying providers relatively low amounts for their services. Co-payments from patients helps restrict the self-referral to specialists and other hospitals without going through the primary care. Managed care stresses on primary care and ensures a low payment of high-cost yet low-priority services. The Affordable Care Act was put in place to provide health coverage is fair and affordable to everyone (Arkoosh, 2012). The summary also contributes to our understanding of ACA through strategic purchasing which protects primary health care services funding by prioritizing primary health care and using incentives to maximize the value of high-cost services. The control of the overall healthcare spending levels helps in the cost-effectiveness of the industry as per the Affordable Care Act.

In conclusion, the document contributes to the public's understanding of strategic purchasing in health care including the payment methodology and the pay for performance programs. The critical facts addressed in summary are the importance of strategic purchasing in guiding the health financing reforms with the sole intent of fostering universal health coverage. Fee For service is identified to increase evidence-based engagement in the industry and improve the health system performance and ultimately the attainment of comprehensive health coverage. It also addressed the main policy issues which are critical for the shift towards strategic health purchasing involving the protection of funding for the principal and primary health care services.

References

Arkoosh, V. (2012). The Patient Protection and Affordable Care Act: no rhetoric, just the facts. Community Oncology, 9(6), 206-209. doi: 10.1016/j.cmonc.2012.05.005

Fee-for-Service vs Managed Care Medicine. (2004). JAMA, 292(2), 170. doi: 10.1001/jama.292.2.170-a

Mathauer, I., Dale, E., & Meessen, B. (2017). Strategic purchasing for universal health coverage: key policy issues and questions, World Health Organization Health Financing.

Moving from passive to strategic purchasing. (2018). Retrieved from http://www.who.int/health_financing/topics/purchasing/passive-to-strategic-purchasing/en/