Strategic purchasing and health systems resilience: Lessons from COVID-19 in selected European countries

Montás, Marie C.; Klasa, Katarzyna; Ginneken, Ewout van; Greer, Scott L.

doi:10.1016/j.healthpol.2022.06.005

Cited by 9 publications

(5 citation statements)

References 19 publications

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“…In this respect, Montás et al developed a study for six EU countries and found that strategic buyers responded to seven health system shocks, with each country relying on the federal government for funding and response. Buyers often have limited, passive roles in contributing to a resilient health system, the need for strategic procurement in addressing health system challenges being very important (Montás et al 2022).…”

Section: Resultsmentioning

confidence: 99%

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

Dincă,

Antohi,

Andronic

et al. 2023

Economies

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This paper makes a comparison between the financing of health systems in six European Member States: France, Denmark, Spain, Bulgaria, Romania and Hungary, starting from the structure of financial allocations to health systems in the context of fluctuating macroeconomic developments marked by multiple economic crises and the onset of the pandemic, which posed a real challenge to maintaining the health security of the European population and beyond. The need for this research is connected to the gap in the literature regarding economic development, health management and health financing performance. The main objective of the research is to determine the performance aspects of health systems financing and efficient financing models in relation to the evolution of macroeconomic indicators such as gross domestic product, household final consumption, general public expenditure and population. Empirical and analytical methods consisting of literature review, database construction, econometric modeling and statistical model validation were used. The results of the study highlight the performance of financial allocations for the six countries analyzed and could help decision-makers adjust health financing strategies in line with the insights provided by the current research. The novelty of this research is the comparison between different EU member states according to their economic development level in direct connection with health financing performance. This paper identifies the key aspects of health systems’ financing and of efficient financing models in connection to the evolution of main macroeconomic indicators.

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Section: Resultsmentioning

confidence: 99%

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

Dincă,

Antohi,

Andronic

et al. 2023

Economies

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“…Yet, they are in stark contrast to how the health sector responded in high-income countries, in particular, by adjusting their payment methods, backed by additional funding, although with a closer look, there were also variations found within this country group. One commonality with high-income countries, however, relates to the rather passive role of purchasers, such as under social health insurance schemes, in COVID-19-related decision-making in purchasing ( Montás et al ., 2022 ; Schmidt et al ., 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, in European countries, a key policy response was to ensure that COVID-19 health services were free of charge ( Thomson et al ., 2022 ). Moreover, governments and public payers assumed most of the COVID-19-related financial risks of providers ( Montás et al ., 2022 ; Schmidt et al ., 2022 ; Waitzberg et al ., 2022 ), as in many countries hospitals received their usual budgets or additional funds to compensate for revenue shortfalls ( Quentin et al ., 2020 ). Overall, the evidence shows that the structure and financing of health systems affected the capacity of providers to cope with the pandemic ( Waitzberg et al ., 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries

Parmar,

Mathauer,

Bloom

et al. 2024

Health Policy and Planning

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The COVID-19 pandemic has triggered several changes in countries’ health purchasing arrangements to accompany the adjustments in service delivery in order to meet the urgent and additional demands for COVID-19 related services. However, evidence on how these adjustments have played out in low- and middle-income countries is scarce. This paper provides a synthesis of a multi-country study of the adjustments in purchasing arrangements for the COVID-19 health sector response in eight middle-income countries (Armenia, Cameroon, Ghana, Kenya, Nigeria, Philippines, Romania and Ukraine).We use secondary data assembled by country teams, as well as applied thematic analysis to examine the adjustments made to funding arrangements, benefits packages, provider payments, contracting, information management systems, and governance arrangements as well as related implementation challenges. Our findings show that all countries in the study adjusted their health purchasing arrangements to varying degrees. While the majority of countries expanded their benefit packages and several adjusted payment methods to provide selected COVID-19 services, only half could provide these services free of charge. Many countries also streamlined their processes for contracting and accrediting health providers, thereby reducing administrative hurdles. In conclusion, it was important for the countries to adjust their health purchasing arrangements so that they could adequately respond to the COVID-19 pandemic, but in some countries financing challenges resulted in issues with equity and access. However, it is uncertain whether these adjustments can and will be sustained over time, even where they have potential to contribute to making purchasing more strategic to improve efficiency, quality and equitable access in the long run.

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“…The COVID-19 pandemic critically impacted purchasing patterns and in many countries, purchasing decisions were partly centralised to federal governments, especially regarding public health services. 57 Many decisions involved a trade-off between the so-called precautionary principle and dynamic efficiency. The former, in this context, refers to the application of restrictive and/or costly measures (eg, reserve capacities in hospitals, broad testing campaigns) when conclusive evidence on their effectiveness is still lacking.…”

Section: Bmj Public Healthmentioning

confidence: 99%

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

Reiss,

Kraus,

Riedel

et al. 2024

bmjph

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IntroductionThe COVID-19 pandemic posed an unprecedented challenge, which caught many health systems widely unprepared. The aim of this research was to develop a comprehensive analytical framework on health system resilience in the context of pandemics. In addition to serving as a tool to analyse the preparedness and resilience of health systems, the framework is intended to provide guidance to decision-makers in health policy.MethodsThe analytical framework was developed based on a multitiered approach. A comprehensive review of the existing literature was conducted to identify relevant frameworks on health system resilience (published between 1 January 2000 and 30 November 2021) and determinants of resilience that emerged during the COVID-19 pandemic. Input was then gathered in several rounds of consultations with designated field experts and stakeholders, drawing on their experiences from the pandemic. Finally, the framework was empirically validated in several case studies.ResultsThe framework distinguishes between prerequisites of resilience, pertaining to precautions to be taken in ‘normal’ times, and response strategies in the face of shocks. Both sections are further divided into six building blocks that were adapted from the WHO health system framework: governance and leadership, information and research, financing, physical resources, human resources, and service delivery. An overarching component on contextual factors—subdivided into situational, structural, cultural and international factors—represents an important addition to the existing spectrum of resilience frameworks.ConclusionsFoundations for a resilient health system must be laid in ‘normal’ times and in all areas of the health system. In the face of a shock, adequate response strategies need to be developed. An essential learning from the COVID-19 pandemic has been that contextual factors of societies and subgroups play a major role in the ability of health systems to overcome a shock, as they impact the implementation and effectiveness of crisis management policies.

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Strategic purchasing and health systems resilience: Lessons from COVID-19 in selected European countries

Cited by 9 publications

References 19 publications

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

Modelling Health Financing Performance in Europe in the Context of Macroeconomic Uncertainties

Adjustments in purchasing arrangements to support the COVID-19 health sector response: evidence from eight middle-income countries

What makes health systems resilient? An analytical framework drawing on European learnings from the COVID-19 pandemic based on a multitiered approach

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