In nearly all countries, several payment methods co-exist and constitute a mixed provider payment system (MPPS). Providers are paid by several payment methods and are faced with several incentives that are created through these payment methods and/or rates.
Nevertheless, a frequent challenge in numerous countries is that multiple payment methods and/or different payment rates are not aligned with each other. As such, they may send incoherent and contradictory incentives to health service providers, which may lead to undesirable provider behavior, ultimately affecting UHC objectives.
The Guide proposes conducting an assessment in five steps and offers guiding questions for each step:
• Step 1 Mapping of purchasers, providers and payment methods, and overall context
• Step 2 Assessing incentives created by the mixed payment system and their influence on provider behavior and UHC objectives
• Step 3 Assessing other effects of the mixed payment system on the health system
• Step 4 Assessing governance arrangements and their effects on the mixed provider payment system
• Step 5 Developing policy options
The assessment seeks to inform a national policy dialogue on strategic purchasing and assist in drawing attention to the need of aligning payment methods within and across purchasers as an important step for strategic purchasing and progress towards UHC.
