Strategic Purchasing In Health Care

Alongside with stewardship, creating resources, and service delivery, financing is considered one of quadruplet functions of every health system (1). The ultimate goal of financing is making enough resources so providers can be incentivized for improving access to health services. Success of health care financing depends on efficient performance of three functions: revenue collection, resource pooling and purchasing health services(1, 2).

Purchasing is the process in which pooled resources allocates to a series of effective health services which are useful in promotion of people’s health by payment systems. Purchasing can be either passive or strategic. Passive purchasing is following a predetermined budget or just reimbursing claimed charges.

Strategic purchasing is the key for such a goal (3, 9-11).

Although the theoretical basis for implementing strategic purchasing of health services is rigorous, but in terms of action, health systems who developed this strategy faced several challenges. It is said that strategic purchasing will optimize the outputs and outcomes of health systems, but given the traditional conflict between purchasers and providers it is hard to tell that it would work in any context(12-14).

Countries in the world experienced different kinds of strategic purchasing and they earned advantages. Either in developed countries such as England for health system(15), Canada for home and community care(16), New Zealand for health system(17) and so on, or developing countries like Ghana for some regions(18) or Cambodia to address the poor(19) or Iran for purchasing medicine(20,

Primary health care is delivered by medical universities through network of health. Financing and delivering health services in level one is all by medical universities.(28-30). But in second level of health system Lots of providers and purchasers exist. Large and small insurance organizations, ministry of health, social security organization, etc. purchasing health services from a wide range of providers including medical university hospitals, private providers, and charities, public hospitals form other ministries (for example defense ministry, social welfare ministry, and so on)(28, 31, 32). According to report of Iran ministry of health which published in 2008, variety and complexity of purchasers and providers in Iran health system resulted in high costs and resource consumption- in a parallel level with developed countries but outcomes are not as desired as developed