Strategic Purchasing Solutions in Line with Sustainable Financing of the Health System: A Scoping Review

Abstract

Context: Health financing involves the collection and management of resources necessary for delivering health services. Sustainable financing is crucial for achieving universal health coverage (UHC). By improving access to services and implementing strategic purchasing practices, resources can be used more efficiently, thereby enhancing the quality of care. This study explores strategic purchasing solutions that support sustainable financing for health systems. Evidence Acquisition: In 2024, we conducted a scoping review adhering to PRISMA guidelines to ensure a comprehensive and systematic approach. We developed an extensive search strategy to identify studies related to strategic purchasing solutions that support the sustainable financing of health systems. Our search encompassed the PubMed, Web of Science, Embase, Google Scholar, Scopus, and ProQuest databases, using relevant keywords from December 21, 2002, to December 21, 2024. Ultimately, we analyzed 84 identified records using MAXQDA software and the Arksey and O’Malley framework for analysis. Results: The strategic purchasing solutions identified were categorized into 39 distinct solutions across five main categories. These categories include: Service provider solutions (5), purchaser solutions (6), payment method solutions (14), package solutions (5) and stewardship solutions (9). Among these, the payment method category featured the highest number of repetitions, with performance-based payment being the most frequently mentioned approach. Conclusions: To achieve sustainable health financing through the strategic purchasing of health services, the following approaches should be adopted: Encourage private sector involvement in underserved, low-income regions; foster trust and ensure quality by enhancing credibility and incorporating community feedback; establish negotiated rates with insurers using regulated tariffs and value-based pricing to improve service quality and minimize disputes; introduce a universal basic insurance package to guarantee fair access for all; and prioritize preventive care to reduce long-term healthcare expenses. Moreover, health technology assessment (HTA) should be tailored to address the specific needs of vulnerable populations.