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Table 2.2
The United Kingdom and Canada comparison

Country Key Features of Health Strategic Purchasing Policies & Frameworks
Financing System

United How is the healthcare UK NHS Diabetes Screening (The NHS Diabetes
Kingdom system financed? Prevention Programme (DPP) proposed and currently
piloting 2015 onwards). One of the largest diabetes
Mostly financed screening programmes in the world considering the
through taxation United Kingdom’s population is >67 millions.

NHS funding: • Who is the purchaser?
85% from general
government revenues; NHS England; Clinical Commissioning Groups (CCGs)
12% national health from local sites.
premium tax; 3% from • What to purchase?
copayments.
Behavioural intervention, i.e., dietary and physical activity
Government pays for recommendations, to prevent diabetes among high risk
services, employs population.
doctors, and runs
hospitals. • From whom to purchase?
Supplemental private Behavioural change provider organisations procured by
insurance is rare. NHS England.
• How to purchase?
Financial incentives were offered to GP practices to recruit
patients. The incentives were paid either by capitation
payment, fee-for-service payment, or pay-for-performance
payment.
Canada How is the healthcare Public Health Agency of Canada’s (PHAC) Centre for
system financed? Chronic Disease Prevention (CCDP) launched a
multi-sectoral partnership to Promote Healthy Living and
The public financing of Prevent Chronic Disease Initiative in 2013.
healthcare is funded
by taxation. • Who is the purchaser?
The Canadian government.
The public sector in
Canada is responsible • What to purchase?
for about 70% of total
health expenditures. Evidence-informed interventions that address common
risk factors for chronic disease.

• From whom to purchase?
Both public and private organisations.

• How to purchase?
Pay-for-performance model has been implemented to
improve programme accountability: payments are made
when project milestones are reached. Performance are
evaluated based on project outputs, such as visiting
agreed number of locations, completing evaluation
requirements (e.g., submitting all baseline data) or
developing project resources.

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