Purchasing arrangements to strengthen quality health services for chronic diseases

Implementations
Implementing partners
WHO Kobe Centre (Japan) in collaboration with the WHO Department of Health Financing and Economics (Switzerland) and the Organisation for Economic Co-operation and Development (OECD)(France); The George Institute for Global Health (Australia); Institute of Tropical Medicine Antwerp (Belgium); Mesylab SRL (Belgium); Global Health Research Center, Duke Kunshan University (China); and Center for Health Policy and Management, Gadjah Mada University (Indonesia).
Other participating partners: WHO Regional Offices; University of Technology Sydney (Australia); Health Policy Analysis (Australia); University of Sydney (Australia); Institute of Health Policy, Management and Evaluation, University of Toronto (Canada); Health Economics Department, University of Valparaiso (Chile); Data Science for Health Services and Policy Research, Institute for Health Sciences in Aragon (Spain).
Location of research
Global
Total budget
Background
Improving the quality of care for people with chronic conditions is central to advancing universal health coverage, given the large burden of premature mortality from noncommunicable diseases.
Goal
To describe experiences with purchasing arrangements and payment methods and how they have been used to improve quality and better health outcomes for people with chronic conditions.
Methods
- Scoping review of the literature and other systematic reviews were conducted to identify the effects of payment methods on process quality and outcomes for chronic care.
- Eight case studies were commissioned to describe implementation arrangements for payment methods that reward quality in chronic care in Australia, Canada, Chile, China, Germany, Indonesia, South Africa and Spain.
Key Findings
- A common challenge was balancing the incentives in blended payment methods, i.e. a combination of two or more payment methods.
- Very little information was published about the decisions made to distribute payments across and within teams, which may create uncertainty among health care providers.
- A mix of process and outcomes measures were used in all studies, with a reliance on information collected by existing administrative systems.
- Only two schemes were independently evaluated and peer reviewed, and these evaluations faced important methodological challenges, including selection bias.
- Key facilitating and inhibiting factors included those related to governance, service delivery, quality standards, the health information infrastructure, as well as the financial and regulatory environments.
Global Implications
There is a need to learn from past experiences about the design and evaluation of payment methods, including how lessons learned can be systematically adapted across different country contexts. While proactive learning takes time and effort – particularly across countries and among different stakeholders – it is essential to share experiences to avoid continually repeating mistakes and implementation failures.
Local implications
Relevant initiatives from the Kansai region can further inform these findings including payment for performance initiatives.
Publications
Summary report
Purchasing for quality chronic care: summary report. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Policy brief series
Purchasing for quality chronic care: policy brief series. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Case studies
Australia
- Hall J, van Gool K, Haywood P, Pearse J, Mazevska D, Yu S et al. Australian Health Care Homes trial: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373192. Licence: CC BY-NC-SA 3.0 IGO.
- Australian Health Care Homes offer some promise but fail to meet expectations: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Canada
- Wodchis WP, Rashidian L. Integrated Comprehensive Care programme in Ontario, Canada: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373213. Licence: CC BY-NC-SA 3.0 IGO.
- Building trust to integrate funding and care for chronic diseases in Ontario, Canada: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Chile
- Urriola R, Larrain N. Effect of the payment mix for primary care services on the quality of chronic care in Chile: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373214. Licence: CC BY-NC-SA 3.0 IGO.
- Limited effect of perfomance-related payment incentives on improving the quality of primary care for people with chronic conditions in Chile: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
China
- Long Q, Jia Y, Li J, Lou Z, Liu Y. National Basic Public Health Services Programme in China: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373220. Licence: CC BY-NC-SA 3.0 IGO.
- Capitation with performance payments for universal basic public health services in China: challenges in implementation: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Germany
- Lindner LE. Healthy Kinzigtal Programme in Germany: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373210. Licence: CC BY-NC-SA 3.0 IGO.
- Shared-savings model of integrated care in southwest Germany: promoting patient self-management: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Indonesia
- Nappoe SA, Djasri H, Kurniawan MF. Chronic disease management programme (PROLANIS) in Indonesia: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373226. Licence: CC BY-NC-SA 3.0 IGO.
- Balancing incentives in performance-based capitation for chronic care: the PROLANIS programme in Indonesia: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
South Africa
- Smith A, Mosam A. Value Care Team model in South Africa: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373212. Licence: CC BY-NC-SA 3.0 IGO.
- Value Care Team model in South Africa: small-scale pilot of performance-based capitation for better quality primary care: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Spain
- Bernal-Delgado E, Angulo-Pueyo E. Purchasing arrangements to strengthen the quality of chronic care in three Spanish autonomous communities: case study. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. https://iris.who.int/handle/10665/373225. Licence: CC BY-NC-SA 3.0 IGO.
- Combining global budgeting with other purchasing instruments to strengthen the quality of chronic care in Spain: policy brief. Geneva: World Health Organization, Organisation for Economic Co-operation and Development; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Background papers
- Simmons C, Pot M, Leichsenring K. Scoping review on alternative purchasing arrangements: impact of purchasing, service delivery and institutional design on quality of chronic care. Geneva: World Health Organization; 2023. https://iris.who.int/bitstream/handle/10665/375717/9789240083974-eng.pdf. Licence: CC BY-NC-SA 3.0 IGO
- Effects of purchasing and service delivery on the quality of chronic care: a scoping review: research brief. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
- Role of purchasing arrangements for quality chronic care: scoping review. Geneva: World Health Organization, 2023. https://iris.who.int/handle/10665/376226. License: CC BY-NC-SA 3.0 IGO.
- Varying effects of payment mechanisms on improving the quality of chronic care: findings from a scoping review: research brief. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO
- Quality of care for chronic conditions: literature review and Delphi survey on the possible contribution of purchasing arrangements in low- and middle-income countries. Geneva: World Health Organization, 2025. https://iris.who.int/handle/10665/382496. License: CC BY-NC-SA 3.0 IGO.
Journal articles
- Barber, S.L., Mathauer, I., Rosenberg, M., Larrain, N., Liu, Y., Long, Q., Smith, A., Nappoe, S.A. and Lorenzoni, L. (2025), Purchasing Primary Care Services for Quality Chronic Care: Capitation With Performance Payments in Four Countries. Int J Health Plann Mgmt. https://doi.org/10.1002/hpm.3929
- Simmons C, Pot M, Lorenz-Dant K, Leichsenring K. Disentangling the impact of alternative payment models and associated service delivery models on quality of chronic care: a scoping review. Health Policy. 2024;143:105034. https://doi.org/10.1016/j.healthpol.2024.105034
- Ku GMV, Van De Put W, Katsuva D, Ahmed MA, Rosenberg M, Meessen B. A framework for chronic care quality: results of a scoping review and Delphi survey. Global Health Action. 2024; 17(1). https://doi.org/10.1080/16549716.2024.2422170
- Ku GMV, van de Put W, Katsuva D, Ahmed MAA, Rosenberg M, Meessen B. Quality of care for chronic conditions: identifying specificities of quality aims based on scoping review and Delphi survey. Global Health Action. 2024; 17(1). https://doi.org/10.1080/16549716.2024.2381878
- Meessen B, Rosenberg M, Ku GMV. Improving the quality of chronic care through purchasing arrangements in resource-constrained settings: insights from an international Delphi survey. Global Health Action. 2025;18(1). https://doi.org/10.1080/16549716.2025.2518667