abstract: 'Objectives - Purchasing has been promoted as a key policy instrument to

  improve health system performance. Despite its widespread adoption,

  there is little empirical evidence on how it works, the challenges

  surrounding its implementation, its impact, and the preconditions for it

  to function effectively, particularly in low- and middle-income

  settings. The objective of this chapter is to analyze critically the

  extent to which purchasing could be, and has been used strategically in

  China and to identify modifications that are needed for purchasing to be

  effective in assuring that the government''s new funding for health care

  will result in efficient and effective health services.

  Methods - We present a conceptual framework for purchasing, which

  identifies three critical principal-agent relationships in purchasing.

  We draw on evidence from secondary data, results of other research

  studies, interviews, and the impact evaluation of a social experiment in

  rural China that explicitly used purchasing to improve quality and

  efficiency. This information is used to examine purchasing relationships

  in urban social health insurance (SHI), the rural medical insurance

  scheme, and purchasing of public health services.

  Findings - To date, use of strategic purchasing is limited in China.

  Both the urban and the rural health insurance schemes act as passive

  third-party payers, failing to take advantage of the opportunities to

  strengthen incentives to improve quality and efficiency. This may be

  because as government agencies, the extent to which the Ministries of

  Health and Labor and Social Security can act independently from provider

  interests, or act in the best interest of the population, is unclear.

  Other important challenges include ensuring adequate representation of

  the population''s views and preferences and making better use of the

  leverage provided by purchasing to create appropriate provider

  incentives, through better integration of financing and improved

  coordination among purchasers.

  Implications for policy - In designing purchasing arrangements,

  attention needs to be paid to all three principal agent relationships.

  Successful purchasing appears to require mechanisms to mobilize and

  represent community preferences and more strategic contracting with

  providers. More research is needed to strengthen the evidence on which

  purchasing arrangements work, which no not work, and under what

  conditions different purchasing configurations can work most

  effectively.'
affiliation: 'Yip, W (Corresponding Author), Univ Oxford, Dept Publ Hlth, Hlth Econ
  Res Ctr, Oxford, England.

  Yip, Winnie, Univ Oxford, Dept Publ Hlth, Hlth Econ Res Ctr, Oxford, England.

  Hanson, Kara, London Sch Hyg \& Trop Med, Dept Publ Hlth \& Policy, Hlth Econ \&
  Financing Programme, London WC1, England.'
author: Yip, Winnie and Hanson, Kara
author_list:
- family: Yip
  given: Winnie
- family: Hanson
  given: Kara
booktitle: 'INNOVATIONS IN HEALTH SYSTEM FINANCE IN DEVELOPING AND TRANSITIONAL

  ECONOMIES'
da: '2023-09-28'
doi: 10.1108/S0731-2199(2009)0000021011
editor: Chernichovsky, D and Hanson, K
files: []
isbn: 978-1-84855-664-5
issn: 0731-2199
keywords-plus: DEVELOPING-COUNTRIES; SYSTEM
language: English
number-of-cited-references: '26'
pages: 197-218
papis_id: 919792f70852dd5e76d295044a77fafd
ref: Yip2009purchasinghealth
series: Advances in Health Economics and Health Services Research
times-cited: '15'
title: 'PURCHASING HEALTH CARE IN CHINA: EXPERIENCES, OPPORTUNITIES AND CHALLENGES'
type: article
unique-id: WOS:000270909400009
usage-count-last-180-days: '0'
usage-count-since-2013: '16'
volume: '21'
web-of-science-categories: Economics; Health Policy \& Services
year: '2009'