Is strategic purchasing the right strategy to improve a health system’s performance? A systematic review

Purpose: This study aims to systematically review and investigate the benefits and challenges of strategic purchasing implementation in health systems and suggests a basis for improving their performance. Method: This is a systematic review in which electronic databases and search engines—including PubMed, Springer, OvidSP, ProQuest, Google scholar and Scopus, along with related journals, library, and gray literature—were searched for related articles from 1990 to 2015. Updates were added to the searches if found. Search strategies included the combination of two sets of keywords (“purchasing,” “contracting” OR “commissioning” OR “buying” OR “procurement”) with (“strategic” OR “active” OR “proactive”). Articles in English or Farsi/Persian, which discussed benefits and challenges of strategic purchasing in a health context, were eligible to be included in the study. Two researchers independently completed all steps of the research. Quality assessment of all included articles for final review was done using related checklists. Results: 2049 articles identified through searching databases, which were refined to 23 final articles. Based on the result of this study, the benefits of strategic purchasing implementation in health systems were reported as higher quality, higher efficiency, better value for money (VfM), while high administrative costs, issues in priority setting, a need for accurate information and political issues were among the main challenges and disadvantages. Conclusion: active purchasing can be a healthy useful option for health systems to adequately reach health system objectives, but challenges about functions and especially stewardship of health system should not be neglected.