Samenvatting Healthcare Procurement

SUMMARY HEALTHCARE PROCUREMENT


Summary Healthcare Procurement
Master: HCM/ZOMA
Vak: Healthcare Procurement. GW4009M




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, SUMMARY HEALTHCARE PROCUREMENT



Contents
Summary Healthcare Procurement......................................................................1
Value based procurement................................................................................ 3
Value-Based procurement framework (Bax, Stanberry)...................................8
Purchasing wheel........................................................................................... 11
Reimbursement methods: contract types......................................................14
Public procurement process...........................................................................19
Relational contracting.................................................................................... 21
Sustainability.................................................................................................. 26
The Health insurer.......................................................................................... 28




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Value based procurement
The purchasing function in healthcare is no longer seen as a purely administrative task focused on cost
reduction. Instead, it plays a strategic role in shaping the quality, accessibility, and sustainability of care.

In a healthcare system under pressure from rising costs, workforce shortages, and increasing complexity of care,
effective purchasing and supply management (PSM) is essential to:

 Align resources with health outcomes.

 Enable cross-provider collaboration.

 Promote innovation and value creation.

Thus, purchasing becomes a strategic function when it:

 Influences core service delivery (e.g., commissioning youth care or long-term care).

 Supports public or organizational policy goals (e.g., prevention, equity).

 Shapes provider behaviour through incentives, contract forms, or partnership models.



Goal alignment in healthcare procurement

One of the central challenges in public healthcare procurement is goal misalignment between:

 Purchasers (e.g., municipalities, insurers),

 Providers (e.g., hospitals, care organizations),

 Citizens and patients.

Value-based procurement (VBP) explicitly addresses this by aiming to align purchasing practices with shared
objectives, such as:

 Health outcomes (not just activity levels),

 Patient experience,

 Cost-effectiveness over the care continuum.

This requires translating high-level goals into contractual, financial, and relational mechanisms that drive
behaviours across the care chain. For example, aligning performance indicators in youth care contracts with the
desired long-term outcomes for children and families, not just throughput.

What is VBP?

Value-Based Procurement refers to purchasing strategies that aim to maximize value for patients and society,
rather than minimizing short-term costs. It builds on the idea of Value-Based Healthcare (Porter & Teisberg),
where value is defined as:

Value = Health Outcomes / Costs over the full cycle of care

Key principles of VBP:

 Shift from input- and volume-based purchasing to outcome- and impact-driven procurement.

 Focus on total cost of care rather than price per unit.

 Foster long-term collaboration rather than transactional relationships.

 Use MEAT (Most Economically Advantageous Tender) criteria that incorporate quality, sustainability,
and social value.

Tools and methods include:

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 Outcome-based contracting

 Competitive dialogue

 Innovation partnerships

 Lifecycle costing

 Co-design with providers and users



When is Purchasing Strategic?

Purchasing and supply management becomes strategic when it:

 Influences the organization’s core mission, such as improving child development outcomes in youth
care.

 Engages in market shaping (e.g., stimulating entry of innovative or socially inclusive providers).

 Promotes policy goals (e.g., sustainability, digital transformation, health equity).

 Builds long-term partnerships to improve service delivery.

This contrasts with transactional or tactical purchasing, which focuses on short-term cost, quantity, or
compliance.



The Role of Purchasing in Organisational Performance

Effective procurement contributes to organizational performance by:

 Ensuring cost-efficiency and budget control.

 Driving quality improvement through supplier selection and performance management.

 Supporting innovation and process redesign (e.g., digital health, community-based models).

 Enhancing resilience and continuity of services, especially during demand shocks.

For municipalities responsible for social care and youth services, purchasing decisions influence not only
organizational costs but also citizen well-being, social cohesion, and public trust.

Youth Care Procurement by Municipalities: Processes, Challenges, and Dilemmas

Since the decentralization of Youth Care in the Netherlands (2015), municipalities are responsible for
commissioning youth services. This shift has introduced several challenges and dilemmas:

Key Process Challenges:

 Fragmentation: Many small providers, varied quality.

 Procurement capacity: Municipalities often lack expertise in complex contracting.

 Data limitations: Difficulties in linking spending to outcomes.

 Financial pressure: Budget cuts drive focus on volume and price, undermining VBP.

Strategic Dilemmas:

 Relational vs. transactional procurement: Should municipalities build long-term trust with providers or
compete annually on price?

 Outcomes vs. outputs: How to reward providers for long-term youth well-being rather than short-term
interventions?


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 Equity vs. efficiency: How to support smaller local providers without sacrificing scalability or
performance?

Solutions under development:

 Outcome-based commissioning pilots.

 Collaborative purchasing across municipalities (regional tendering).

 Use of competitive dialogue and relational contract models.

 Integration of positive health and social return indicators in tender criteria.



Purchasing of Healthcare vs. Purchasing for Healthcare

Purchasing of healthcare:

 Involves the commissioning of clinical services such as hospital care, mental health services, or chronic
disease management.

 Outcomes are often uncertain, multi-dimensional, and difficult to specify contractually.

 Requires flexible, relational, or outcome-based contracts, and may involve procedures like competitive
dialogue or innovation partnerships.

Key characteristics:

- Complex and person-centered services: Healthcare services are not uniform commodities.
They vary across individuals, populations, and care trajectories, making them inherently
difficult to define in advance.
- Outcome-driven: The objective is not just to purchase activity or capacity (e.g., number of
consultations), but to achieve tangible health outcomes (e.g., reduced hospital admissions,
improved quality of life).
- Information asymmetry and dependency: Public purchasers often lack full visibility into the
medical knowledge, quality practices, or cost structures of provider
- High relational and coordination needs: Purchasing often requires relational contracts, long-
term collaboration, and joint governance, especially in integrated care models.

Purchasing for healthcare:

 Refers to the acquisition of supporting products and services—e.g., IT systems, building maintenance,
diagnostic equipment.

 These purchases are typically more transactional, allowing the use of open or restricted procedures
with clearly defined specifications.

Key characteristics:

- Standardized or semi-standardized products and services: Specifications (technical, quality,
volume) can usually be defined in advance.
- Focus on inputs rather than outcomes: The procurement goal is to ensure reliable delivery of
equipment, materials, or external services, not to improve health outcomes directly.
- Transactional in nature: There is often less need for long-term relational contracting, although
framework agreements or bundled services may still apply.

Maturity




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