Strategic purchasing is one of the key policy instruments to achieve the universal
health coverage (UHC) goals of improved and equitable access and financial risk
protection. Given favourable outcomes of Universal Coverage Scheme (UCS),
this study synthesized strategic purchasing experiences in the National Health
Security Office (NHSO) responsible for the UCS in contributing to achieving
UHC goals. The UCS applied the purchaser–provider split concept where NHSO,
as a purchaser, is in a good position to enforce accountability by public and
private providers to the UCS beneficiaries, through active purchasing. A
comprehensive benefit package resulted in high level of financial risk protection
as reflected by low incidence of catastrophic health spending and impoverished
households. The NHSO contracted the District Health System (DHS) network, to
provide outpatient, health promotion and disease prevention services to the
whole district population, based on an annual age-adjusted capitation payment.
In most cases, the DHS was the only provider in a district without competitors.
Geographical monopoly hampered the NHSO to introduce a competitive
contractual agreement, but a durable, mutually dependent relationship based
on trust was gradually evolved, while accreditation is an important channel for
quality improvement. Strategic purchasing services from DHS achieved a propoor
utilization due to geographical proximity, where travel time and costs were
minimal. Inpatient services paid by Diagnostic Related Group within a global
budget ceiling, which is estimated based on unit costs, admission rates and
admission profiles, contained cost effectively. To prevent potential underprovisions
of the services, some high cost interventions were unbundled from
closed end payment and paid on an agreed fee schedule. Executing
monopsonistic purchasing power by NHSO brought down price of services
given assured quality. Cost saving resulted in more patients served within a
finite annual budget.