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same note, our key stakeholder interview findings also revealed the importance of
collaborating and gaining input from various industries in the Scheme’s design for desirable
results. Based on our findings, we recommend that the stakeholders with whom alignment
should be ensured include the pharmaceutical industry, insurance industry, and existing
primary care providers in the public sector such as DHCs, and integration of the Scheme
with existing programmes such as the EHCVS should be ensured.

3.5 Incorporating cost-effective contracting

Policy clarity and definition of the contracting process (specifically, the payment system and
financing mechanism between purchasers and providers) is a key component of strategic
purchasing. “Good contracting” will have clearly stated terms and criteria, as well as
measurements of its effectiveness, that are based on evidence, premised on the availability
of a health system’s data on health status, health needs of its populations, and the efficiency
of existing health programmes and service models. Provider payment systems should be
aligned with benefit package design with consideration to the transfer of risk from the
purchaser to service providers while maintaining communication between both parties and
with patients.

To facilitate cost-effective contracting in PPP programmes, supply-side and demand-
side factors need to be strategically addressed to promote PPP participation of providers
and users. Identified barriers that deter participation need to be addressed and incentives to
encourage participation considered. For instance, to maximise provider participation, the
Government and purchaser should work towards streamlining administrative
requirements and disseminate clear guidelines and information on the
payment mechanism to service providers.

In relation to transfer of risk from the purchaser to service providers, we recommend the
implementation of a management Scheme for HDH in the private sector
for diagnosed HDH patients, modelling off the RAMP programme
currently implemented in the public sector. The parallel RAMP protocol and
programme should have in place defined risk-sharing arrangements between the public and
private sectors. For instance, patients should be able to attend their RAMP programme in the
private sector as they need, but if their conditions worsen and they require acute hospital
inpatient services, patients should be referred to public hospitals. This will require the
development of clinical guidelines and protocols. This sharing of risk perceivably helps to
incentivise private sector providers to partake in the Scheme and simultaneously help
manage the increasing healthcare demand on the public sector.

At the same time, clear guidelines on payment to providers should be disseminated, and the
attainment of a quality standard be made a determining factor of contract renewal. Common
clinical protocols, shared staff training and development programmes between the public
and private sectors could also be considered.

RECOMMENDATION 4. Health system strategic
purchasing should be implemented for achieving an
integrated care system to enable health for all

Beyond application to specific healthcare programmes, strategic purchasing should also be
positioned as a key policy lever for health system transformation towards one that is primary
care-led, integrated and person-centred. This involves relevant decisions for strategic
purchasing to be considered, including interconnected objectives and goals together with an
aligned accountability structure across all three levels of the health system that include
macro- (health system), meso- (healthcare delivery) purchaser-provider system, and micro-
(person journey of healthcare delivery) levels (Figure B) (WHO, 2012).

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