Resource Type: Guide
Authors: Altea Cico, Kelley Laird, and Lisa Tarantino
Published: September 2018

Resource Description: The purpose of this guide is to support policymakers when they are defining the institutional roles, relationships, and capacities of payers in carrying out strategies for improving the quality of care. We intend government policymakers and institutional actors, including from ministries of health and payers, along with donors and implementing partners to use this guide as a diagnostic and planning tool. Specifically, the guide focuses on:

1. identifying strategies whereby payers can leverage their power to enhance the quality of care,
2. articulating possible institutional arrangements (among payers and other actors), and
3. presenting a process to establish or improve those
   arrangements in a particular country.

The guide describes how payers can use various health financing levers, such as selective contracting, provider payments based on quality, etc. (see Section 2), to drive health sector performance. We assert that the road to UHC is path dependent, and each country will pursue different institutional configurations to provide health services. However, there are promising practices and key considerations for optimizing the role of the payer, whether that payer is a social health insurance scheme, national purchasing agency, private health insurance agency, large employer, or ministry of health (MOH). Importantly, there are promising practices for ensuring collaboration between the payer and other institutions working to ensure and improve quality.

The guide is designed to help countries systematically think through the institutional architecture and mechanisms currently used in a country to govern for quality, and to provide country policymakers with tactics for defining and clarifying institutional roles and responsibilities to ultimately optimize the role of the payer for improving quality of care. We have identified six strategies that payers can use to improve the quality of care. For each of the strategies, we provide key considerations and promising practices for structuring roles and responsibilities and clear coordination and collaboration procedures between the payer and other quality stakeholders.