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of providers to instantaneously share information with purchasers and policymakers. When
designing and orienting an information management system for strategic purchasing, it is
critical that such systems be dynamic and adaptive, while maintaining a clear vision of the
systems’ functions and objectives.

Benefit package design

The benefit package design has one of the most direct impacts on beneficiaries as it
determines what services are available for access. The benefit package refers to the services
that are purchased and paid for by the purchaser using pooled funds for beneficiaries.
A package can be considered a health system commitment to the provision of specified
services by designated providers in full as an entitlement to beneficiaries. The WHO suggests
using the principle of “whatever is promised, should be delivered” to understand how benefit
packages should be interpreted. The benefit package is intrinsically tied to the management
of health financing based on revenue raising, funds pooling, and purchasing. Policymakers
are thus required to explicitly determine which services are to be covered fully through
budget allocations and which should be covered by separate purchasers. The benefit
package should be made with financial sustainability in mind, with service coverage that is
equitable and addresses population health needs, but not excessive as to be overly costly
and take a significant share of health services funding.

Selecting providers

To manage alignment and dynamics within the strategic purchasing process, the health
system must account for existing resources that it can leverage upon to achieve health
system goals, namely healthcare service providers. Purchasers or the government need to
specify how and what it will purchase from which levels of providers and if these providers
will be from the public sector and/or the private sector, using criteria based on their capacity
towards providing covered services, interventions, and medicines. Accreditation as well as
selective contracting are key instruments in strategic purchasing for selecting providers.
Specifically, an accreditation process examines a healthcare provider’s capacity to meet
defined quality related standards (e.g., related to structure, process and/or outcomes). As a
result, the accreditation results provide relevant information to the purchaser about provider
performance. Through selective contracting, a purchaser may choose between (competing)
providers–in other words, it has a right not to contract with all available providers. This
selection can be based on predefined criteria or a provider’s accreditation results in order to
further incentivise quality and good performance. Furthermore, the contracting of providers
and selection mechanisms should complement the health system and health financing
reforms and must respond to changing contexts and dynamics of the health system.

Mixed provider payment systems
Mixed provider payment systems are key components for the core function of health
financing because of its value in incentivising necessary healthcare services from the
provider-end, such as primary care, and in reforming how payment schemes can be varied
and combined for performance management to promote better care. The term “mixed” in
“mixed provider payment” refers to the use of different payment schemes for different
services or providers with the goal of shifting to a system perspective. Aligning payment
schemes to performance-based financing will create a greater understanding of underlying
incentives for providers and guide purchasers in designing a better system. In considering a
mixed provider payment system, the WHO states that contexts and health system objectives
are critical in determining how to create an efficient payment scheme (WHO, 2019b). The
context for each payment system is defined by a multitude of factors including the level of
decentralisation within purchaser capacities, the degree of provider autonomy, and the type
and level of care (such as family practice, emergency care, and chronic care) with the
underlying goal of reducing secondary and tertiary care provision. Ultimately, strategic
purchasing aims to link payment schemes to performance-based financing, so that service
provision may be optimised for best population health results.
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