The functions and governance of purchasing agencies: issues and options for Georgia
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World Health Organization. Regional Office for Europe
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48 p.
This paper discusses the key functions and governance structures of purchasing agencies in single-payer health systems. It is based on policy discussions that took place between WHO and the Ministry of Labour, Health and Social Affairs in Georgia following the introduction of major reforms to the Georgian health system in 2013. This paper summarises those discussions. It draws on case studies of other countries deemed relevant to Georgia’s circumstances, noting some distinctive challenges Georgia faces in strengthening purchasing because of the dominance of private for-profit health care providers that currently face very light regulation. Although the starting point for the paper’s analysis is the situation in Georgia, its contents are relevant to debate about the functions and governance of purchasing agencies in other countries at all stages of economic development. The paper concludes that the extent of independence and decision-making authority given to a single purchaser needs to be commensurate with its level of capacity and accountability. To guide detailed decisions on the legal model, governance, powers, functions and structure of a purchasing agency, a government first needs to clarify its vision for the agency, recognizing that it may take time to build up capacity for active, strategic purchasing.
This paper discusses the key functions and governance structures of purchasing agencies in single-payer health systems. It is based on policy discussions that took place between WHO and the Ministry of Labour, Health and Social Affairs in Georgia following the introduction of major reforms to the Georgian health system in 2013. This paper summarises those discussions. It draws on case studies of other countries deemed relevant to Georgia’s circumstances, noting some distinctive challenges Georgia faces in strengthening purchasing because of the dominance of private for-profit health care providers that currently face very light regulation. Although the starting point for the paper’s analysis is the situation in Georgia, its contents are relevant to debate about the functions and governance of purchasing agencies in other countries at all stages of economic development. The paper concludes that the extent of independence and decision-making authority given to a single purchaser needs to be commensurate with its level of capacity and accountability. To guide detailed decisions on the legal model, governance, powers, functions and structure of a purchasing agency, a government first needs to clarify its vision for the agency, recognizing that it may take time to build up capacity for active, strategic purchasing.