Strategic purchasing for universal health coverage: the importance of aligned mixed provider payment systems

Overview

When: 12 March 2019
What: 5th AfHEA Biennial Scientific Conference, Accra, Ghana

Making purchasing of health services more strategic is important for countries to progress towards universal health coverage. Provider payment methods are one important aspect of purchasing, as they set incentives to providers which influences their behavior and use of resources. In many African countries, health providers are paid by several purchasers and different payment methods; this creates a mixed provider payment system.

WHO organized a session at the African Health Economics and Policy Association conference in Accra to present its work on mixed provider payment systems. A short introduction encouraged participants to reflect on how providers are payed in their own country. A conceptual presentation by Inke Mathauer and Fahdi Dkhimi of the WHO Analytical guide to assess a mixed provider payment system followed. This WHO Guide outlines how multiple payment methods create a set of incentives, and how these may affect provider behaviour and UHC objectives. The conceptual framework was illustrated by findings from two case studies on Egypt, presented by Ahmed Khalifa, and Burkina Faso, presented by Joël Kiendrebeogo. Ayako Honda, as a discussant, provided a critical reflection of the conceptual framework focusing on provider behaviour responses to different incentives. A group discussion explored practical measures to align a mixed and uncoordinated provider payment systems and ways to restrict provider behaviour that is inconsistent with UHC objectives.

Key messages from the session include:

• It is important to understand a country’s payment system as a mixed system, which is, in many countries, a non-aligned, uncoordinated payment system.
• A non-aligned payment system may send a set of incoherent or even conflicting incentives to providers which can lead to provider behaviour that is not conducive to UHC objectives.
• The WHO Analytical Guide can support a country to assess its mixed provider payment system in a systematic and comprehensive way. On this basis, ministries of health or purchasing agencies can identify options to improve alignment of the payment of system.
• Effective governance arrangements are needed to be able to move towards stronger alignment of a payment system (e.g. standardization of payment methods and rates) and to reduce provider behaviour that is non-conducive to UHC objectives.
• Specific steps include improving information on provider activity, designing clear contracts between purchasers and providers, and enforcing regulations.