Strategic Purchasing in China, Indonesia and the Philippines

Overview

Despite the important role of purchasing in health systems performance, there is very limited empirical evidence on purchasing arrangements in the lower middle income countries.

The APO in collaboration with the RESYST (Resilient and Responsive Health Systems) Research Consortium undertook a study to investigate the purchasing arrangements for health care financing systems of China, Indonesia and the Philippines. RESYST’s multi-country study also covers India, Kenya, Nigeria, South Africa, Tanzania, Thailand and Viet Nam. The study aimed to describe the current purchasing mechanisms in participating countries; critically assess the existing purchasing performance in the promotion of financial risk protection and the provision of equitable health services; identify factors that enable or hinder effective purchasing and potential mechanisms to address these factors; and make policy recommendations to promote effective purchasing arrangements for universal coverage.

Each country case study focuses on existing purchasing mechanisms and actual practice to assess the performance of health care purchasers and identify factors that influence performance by using a framework that examines relationships between different actors: purchaser – citizens, purchaser – provider, and purchaser – government.

The China case study examines the New Rural Cooperative Medical Scheme, a mandatory insurance scheme for the entire Chinese rural population. The Indonesia case study examines the Jaminan Kasehatan Nasional (National Social Security), a single pool mandatory health insurance scheme for the poor, government and company employees with expansion planned to reach the entire informal sector. The Philippines case study examines the National Health Insurance Program, a single pool mandatory health insurance scheme for the entire population, which currently covers 74.9% of the population.