This document sets out an analytical framework for assessing a country’s governance arrangements for the purchasing function. The purpose of such an assessment is to assist policy-makers and policy advisors in determining whether the existing governance arrangements for the purchasing function are conducive to more strategic purchasing. It can identify gaps in governance arrangements that prevent more strategic purchasing and options for overcoming those gaps.
The analytical framework takes a comprehensive approach to governance. It is designed for assessing the governance of both the health care purchasing system and of an individual purchasing agency, thereby focusing on mandatory health insurance and government health purchasing schemes.
Governance is an overarching health systems function and is about “ensuring strategic policy frameworks exist and are combined with effective oversight, coalition-building, regulation, attention to system-design and accountability”. It equally applies to specific health system components as well as aspects of health financing. Effective governance arrangements constitute a critical enabler for strategic purchasing, i.e. making purchasing more strategic requires strong coordination of all key actors, clear decision-making rules and appropriate regulations.
