Scoping review of purchasing arrangements for quality chronic care



Kai Leichsenring


Cassandra Simmons, Mirjam Pot, Klara Lorenz-Dant


As the result of population aging and rising prevalence of chronic diseases, states have faced escalating pressure to reform the delivery and financing of services for treatment of chronic diseases to be more efficient, sustainable and value-driven. The development of organisational structures and financial mechanisms that incentivise stakeholders to positively act have been recognised as key levers for enabling and improving the quality of care. So far, however, evidence on innovative purchasing arrangements (beyond pay-for-performance mechanisms) and their impact on quality of chronic care services is missing.


This project aimed to map evidence of innovative purchasing arrangements beyond pay-for-performance measures that have been used to strengthen service delivery models for people living with chronic diseases through a scoping review, as well to identify the mechanisms through which these purchasing arrangements have impacted the quality of care. More broadly, the scoping review aimed to inform a WHO technical paper that provided guidance to countries on designing and implementing purchasing arrangements for quality chronic care.


A scoping review of academic and grey literature on innovative purchasing arrangements (excluding pay-for-performance schemes) and their impact on the quality of chronic care was carried out.


  1. Development of the research protocol
  2. Conducting systematic search
  3. Title & abstract screening, followed by full-text review and data extraction
  4. Analysis of results
  5. Presentation of results through a report, policy brief and academic article

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