Verification and monitoring of results and strategic purchasing

The aim of the study was to highlight the different verification processes that four countries and one province take to monitor efficiency, quality, coverage, financial protection, and health outcomes in health systems. The literature review focused on the experiences of England and Sweden, illustrating a comprehensive verification process. Norway, the Canadian province of Ontario, and Turkey collected data on health care provider performance but did not publicly report it. Different instruments were used. Performance measures of patient-reported experiences, compliance with clinical guidelines, and waiting times have become common measurement-based indicators. To improve verification processes, it is necessary to maintain accountability between providers and governments to ensure that the overall objectives of health care are achieved. Monitoring effective service coverage includes measuring the population in need of the service using administrative records from service providers, determining the effectiveness of service coverage using selected indicators, and monitoring equity in access to quality health services using data disaggregated by inequality dimensions. Verification of results is essential within the context of institutional arrangements for the purchasing of health care services to providers. There is autonomy over several significant decision areas such as staffing (numbers and skill mix); financial management (ability to take loans); the scope of activities and capital investments; governance mechanisms that make providers accountable to purchasers; and conditions that balance the power between purchasers and providers. Within this context, monitoring and verification of results is critical to enhance the performance of service providers and ensure value for money within health expenditure. This would be strengthened by previously agreed standards between providers and the implementing agency. Setting strong monitoring and verification procedures has become a key factor in the success of Results-Based Financing programs in general, strengthening health information and governance structures are the most valuable ‘spillover effects’ of such programs.