Chronic diseases are the number one cause of death and disability globally. With rapid population ageing, countries are facing challenges to manage public spending on health while ensuring quality healthcare delivery.
Policy-makers need evidence from a wide choice of arrangements to improve the provision of care for people with chronic diseases. However, there was a research gap about the mechanisms through which purchasing and payment together with service delivery can improve the quality of care of chronic illness patients, and if they can be applied to other contexts.
The WHO Centre for Health Development (WHO Kobe Centre – WKC) commissioned a Scoping review on alternative purchasing arrangements to identify population-based payment models that go beyond traditional fee-for-service and pay-for-performance models to explore those that reimburse providers based on quality and coordination of services. The review also assessed how these had improved the quality of care for patients with chronic diseases.
Through analysis of 51 reports, the review identified five distinct clusters of purchasing arrangements, each with some positive impact on quality of chronic reported but mostly with low levels of certainty. The results highlight several findings to be considered when designing purchasing arrangements and their service delivery models, particularly how these arrangements can impact providers’ behaviour.
This was a background study which informed the WHO/OECD joint publication Purchasing for quality chronic care: summary report