2015, Number 2
The strategic purchasing of health services: a big opportunity for the National Universal Health System
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ABSTRACTHealth professionals and sector policy specialists coordinated by the Centro de Estudios Espinosa Yglesias in Mexico propose a policy to anchor the health system in primary care centered on the individual. The vision includes effective stewardship, solid financing, and the provision of services by a plurality of providers – including eventually those in the private sector. A unified approach to financing health through a unique, exclusively tax-based fund would be established. Alternatives are proposed to establish a service packages, whether through a single obligatory list or through the definition of a flexible, high priority set to be offered to specific populations according to their economic possibilities. For the strategic purchasing of services, two alternatives are proposed: to assign the fund either to a single national manager or to each of the existing public provider institutions, with the expectation that they would contract across each other and with private providers to fulfill their complementary needs.
The proposal does not consider the risks and alternatives to a single tax contribution fund, which could have been suggested given that it is not an essential part of a National Universal Health System. However, it is necessary to discuss in more detail the roles and strategies for a national single-payer, especially for the strategic purchasing of high-cost and specialized interventions in the context of public and private providers. The alternative of allocating funds directly to providers would undermine the incentives for competition and collaboration and the capacity to steer providers towards the provision of high quality health services.
It is proposed to focus the discussion of the reform of the national health system around strategic purchasing and the functions and structure of a single-payer as well as of agencies to articulate integrated health service networks as tools to promote quality and efficiency of the National Universal Health System. The inclusion of economic incentives to providers will be vital for competition, but also for the cooperation of providers within integrated, multi-institutional health service networks.
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