Funding services or purchasing clinical outcomes

Suppose we have universal coverage and enough resources to finance the services a population needs. One decisive question remains: how should the organizations that deliver those services be paid? I am Magín Eduardo Blasi Blanchard, and I believe this decision shapes much of a system's real quality.

Activity does not necessarily equal better outcomes

Under fee-for-service payment, each consultation, test, procedure or admission can generate revenue. This model recognizes specific activities, but it can also encourage volume without ensuring that every intervention is necessary or improves a patient's health.

A person with diabetes does not simply need more visits; they need appropriate care that prevents complications. A surgical patient needs more than an operation: they need a safe intervention, sound recovery and follow-up.

Purchasing services strategically

The WHO describes strategic purchasing as allocating resources with reference to population needs and provider performance. It means deciding what to buy, from whom, how to pay and how to oversee delivery.

I propose that contracts include indicators for safety, clinical quality, patient experience, continuity of care and efficient resource use. Payment can combine different methods depending on the service; no single arrangement fits every case.

Measure well to avoid harmful incentives

Evaluation must account for patient complexity and differences between institutions. Comparisons without risk adjustment can unfairly punish centers that receive the hardest cases. Incentives must also avoid encouraging providers to reject complex patients or reduce necessary care.

Electronic health records, interoperable systems and data analysis can support measurement, but they require reliable information, governance and privacy controls.

A shared objective

The purpose is neither for hospitals to bill more nor for payers to spend less at any cost. It is to ensure every person receives clinically necessary, safe and effective care while resources are used responsibly.

The goal is not more procedures, but appropriate, safe and effective care.

References

The WHO discusses strategic purchasing and related quality tools.