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Figure B
Health system strategic purchasing: the application of strategic
purchasing across macro-, meso- and micro- levels of the health system

Macro-level: Health system strategic purchasing
Governance Policy parameters Collaboration Oversight &
Accountability
• Assessment of • Health system • Engagement/
population health objective & policy Participation/ • Selective
needs and goals Communication contracting
equitable access • Who to purchase • Feedback and • Licensing and
to integrated care timely response accreditation
• From whom to
• Healthcare delivery purchase • Credibility/trust • Monitoring and
evaluation evaluation
• Contracting/
• Policy instrument commissioning • Reviewing and
choice auditing
• Policy guidance
• Make or buy and authorisation
• Strategic resource for purchasers on
allocation to purchasing
commissioners decisions
and purchasing
agents

Meso-level: Healthcare delivery purchaser-provider system
Purchasing, Integration of health Systems for Monitoring for
Commissioning and services coordination results
Provider System
• Mix, types, • Care pathways • Review of process
• Roles, authority, settings, and • Clinical protocols • Monitoring and
and obligations of providers of care evaluation of
purchasers, • Networking of • Multidisciplinary access, safety,
commissioners services and engagement quality assurance,
and providers agreements on • Clustering of and audit systems
• Engagement with resource primary and • Patient complaints,
governance to deployment specialist services redress, and
align functions • Bridging for vertical feedback systems
• Structure for mechanisms and integration • Patient satisfaction
communication structures for care • Networking of and reported
and collaboration transitions service types for outcomes surveys
with health and horizontal
community integration
stakeholders

Micro-level: Person journey of healthcare delivery
Integrated care Person centredness Holistic care
• Timely access to preventive, • Redesign of care process • Monitoring of care
curative, rehabilitative, around patients processes
palliative and social care
• Protocols for engagement • Assessing access,
• Multidisciplinary engaged in decisions affordability and continuity
teams • Culture for care to be of care
• Clinical protocols appropriate to the needs • Review of patient journey
• Service navigation systems and preferences of each and experience
person
• Provider transition review • Evaluating interventions for
• Performance incentives for co-production of health
• Affordability and equitable person centredness
access to care
Source: WHO, 2012

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