Strategic Purchasing of Healthcare Services in Developing Countries: A New Approach Is Required

The proper purchasing of services has always been one of the major concerns of health insurance. Inattention to the optimum purchase of services has led to serious problems for health systems. Traditional (passive) purchasing has some weaknesses because of problems such as low efficiency in the health system, no targeted resources, low cost-benefit and cost-effectiveness indicators and poor justice in access to services. To solve these problems, WHO, introduced strategic purchasing as a central activity to improve health system performance (1). Many countries adopted this strategy within their health system but the process of strategic purchasing in middle-income countries where the passive purchasing elements dominate is considered as a challenge facing the financial protection and efficiency of health services. In order to implement this strategy in Iran, the government obliged the health insurance organizations to comply with the referral system and classify services based on the policies approved, so that they could take actions for the strategic purchasing of health services from the public and non-governmental sectors. However, appropriate actions have not been taken to implement this important strategy after several years of obligation of the health insurance organizations and there is only a mention of obligation in the upstream documents. An important question is why developing countries, including Iran, failed to implement the strategic purchasing? There has been a perception in the health insurance system of Iran that strategic purchasing is possible only if all the conditions are met and good progress in strategic purchase can be made when all necessary actions are taken. Certainly, it is difficult to provide ideal conditions for a strategic purchasing in these countries, as a result of the existence of major problems. Insurance organizations can take some actions through simple solutions in the field of strategic purchasing. Some solutions are mentioned as follows: Critical bottlenecks should be identified in the strategic purchasing and reviewed consciously. One of the main bottlenecks in the strategic purchasing is the type of services and goods purchased (what should be bought?). To respond, the state of the country's service package should be determined. The present package in Iran has some major problems, including inappropriate information system, inappropriate mechanisms and criteria covering services, and inappropriate trustee for determining the service package and