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Contractual obligations of providers, performance monitoring and audits should be centred
on timely access of patients to multidisciplinary care and experienced seamlessly in a
coordinative system of integrated provider organisations. This should include care pathways
to integrate care across provider transactions and patient feedback and redress systems and
survey instrument for patient satisfaction and patient-reported outcomes.

5.4.3 Person journey of healthcare delivery

The micro-level relates to the person healthcare journey during a life course including
encounters with multiple disciplines of healthcare professionals from different specialties in
different settings. Encounters are also at different levels of health services attended by a
multitude of providers in public and private sectors managed in their unique organisation
cultures and defined by provider policies. The final product of strategic purchasing is what
matters at the interaction of patient care delivery with the person and how the model of
patient care can be redesigned to centre on the individual and to enable a seamless journey
in care delivery over a life-course in preventive, curative, rehabilitative, palliative and social
care provided by multidisciplinary team of health professions. Purchasing should also assess
the inputs, processes outputs and outcomes of patientcare delivery. Inputs required include
facilities, equipment, medical products, information, healthcare professionals, supporting
staff and healthcare services. Processes for person-centredness include responsiveness to
individuals’ specific needs and preferences, and participation as an equal partner in the
coproduction of health. Also important are mechanisms to navigate patients in this complex
and constantly evolving system of care delivery and in the transitions of care.

What should be purchased in addition to this holistic-person centred care are the bridging
and coordinating mechanisms required for vertical integration in the transitions (transitions of
care within and between primary, secondary and tertiary levels of care) and horizontal
(between different types and specialties of care, between social and medical care, and in the
transitions to and from the community) integration. How to purchase should consider the
goal of holistic care over a life course and for this temporal integration of care to consider
capitation payment and personal budget allocations. Performance incentives for person
centredness should also be built into contracts and agreements. Monitoring and evaluation
tools should include assessment of responsiveness, equitable access, appropriateness,
affordability and continuity surveys of patient experience, satisfaction and patient reported
outcomes, in addition to patient complaints and redress procedures. Patient safety and
quality and clinical audits are complements to the other mechanisms.

Ultimately the integrated journey of holistic care of individuals across the life course is of
essence. Strategic purchasing needs to incorporate a bottom-up perspective to link the three
levels of governance–provider–delivery. Adequate linkages will ensure the purchaser is
getting the product paid for and that service provision does not require extraneous payments
by patients. This arrangement thus allows the health system to avoid pitfalls of the principal
agent theory that warns against providers maximising profits at the expense of patients.

In conclusion, beyond facilitating the design of specific healthcare programmes, we put
forward that strategic purchasing serves as a critical policy lever for health system
transformation to achieve a person-centred, integrated care system. Our framework
illustrates how the decisions in strategic purchasing should be considered in the context of
the interconnected objectives and goals at all three levels of the health system, including
macro- (health system), meso- (healthcare delivery), and micro- (person journey of healthcare
care delivery) levels to achieve better integration across preventive, curative, rehabilitative,
palliative and social care provided by multidisciplinary teams. The Government needs to
consider the adoption of health system strategic purchasing in tackling key health system
gaps and combatting health system inefficiencies to achieve an integrated care system–
which is fit-for-purpose.

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