Purchasing arrangements to strengthen quality health services for chronic diseases

Implementations

November 2021 - December 2023

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

US$ 400 000.00

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

Canada

Chile

China

Germany

Indonesia

South Africa

Spain

 

Background papers

 

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