Analytical Framework

The analysis for this paper was guided by the Strategic Health Purchasing Progress Tracking Framework (see Figure 1). The framework focuses on the core purchasing functions of benefits specification, contracting arrangements, provider payment, and performance monitoring, as well as the governance and institutional arrangements that provide oversight and accountability for carrying out the purchasing functions effectively. The framework assumes that when purchasing functions and governance arrangements are in place, the purchaser can directly influence (positively or negatively) the allocation of resources, the incentives that influence individual provider behavior, and accountability through contract enforcement and performance monitoring. Resource allocation, incentives, and accountability can in turn affect overall progress on universal health coverage (UHC) goals. The framework also incorporates factors external to the purchasing arrangements that can either strengthen or weaken the power of purchasers to directly influence resource allocation and provider behavior, such as the share of total health funding managed by the purchaser, public financial management rules, and provider capacity.