Page 222 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

5.4.1.3 Collaboration

Transformation of an integrated health system is exceedingly complex and challenging, and
calls for a shared vision and collaboration of the multitude of stakeholders, in the public and
private healthcare sectors, business and civil society. Structures and mechanisms for
engagement, participation and communications at every stage of the policy formulation,
decision and implementation will enable rich inputs, clarify misconceptions, and address
unrecognised barriers and problems. This would engender not only the buy-in needed for
collaboration but more robust policies and implementation fidelity. Feedback and timely
responses and formative evaluation of policy and programme implementation would build
credibility and trust.

5.4.1.4 Oversight and accountability

A system for oversight and accountability for the decisions made by purchasing agents will
need to be created. Accountability structures and mechanisms, rules and proceeding will
ensure purchasing agents are exercising their delegated authority judiciously and fulfil this
responsibility effectively.

A framework for monitoring of the functions, review of progress, evaluation of performance
and objectives, and information systems will be needed to capture the data on inputs,
access, coverage, continuity and quality. Patient feedback, redress systems, patient
satisfaction and reported outcomes surveys are features of person centredness and is an
integral component of accountability.

5.4.2 Healthcare delivery purchaser-provider system

The meso-level refers to health service delivery and provider organisation. At this level,
strategic purchasing will be focused on the types, range and mix of care for the defined
community which is responsive to changing community healthcare needs. Establishing
structures for coordination between purchasing agents and between commissioning
organisations, and purchasing agents will enable better alignment of roles and functions. This
level also puts focus on the mechanisms for engagement, coordination, and management of
local actors, service providers and health workers. Decisions of what to purchase and from
whom to purchase need to consider how the services types and providers can be linked with
the networks of providers and services types in the integrated system.

A system for coordination will need to be specified in the contracts used in purchasing
and should cover operational, communications and information mechanisms, clinical
protocols and pathways for integrated care.

The purchaser will need to decide how to purchase and which instruments should be used
for the type or sets of healthcare that should be purchased. The payment methods will have
to be devised to incentivise performance and coordination, and should be more effective
when a combination of the available instruments of case-based, capitation, performance-
based, pay-for-coordination and bundled-payment are used. Close monitoring of the effects
will enable timely adjustments and needed changes. The roles of the providers will have to be
defined and the service-mix and types needed to bridge the gaps for integrated healthcare
delivery determined. The relationship and mechanisms for coordination and communications
in the network of service providers need to be clarified. Channels for engagement between
purchaser and provider must be established.

220