Thoughts on the day: strategic purchasing and equity.

Health reform is complex, and simple solutions tend to be elusive. The speakers at the Strategic Levers for a High-Performing Health System symposium presented valuable insights about two key issues confronting health system reform: strategic purchasing and equity. Given the dollars at stake – $148 billion annually and counting in Canada, nearly $100 billion of which comes from the public purse – and the fact that we are often talking about life-and-death decisions, it is hardly surprising that interests, power and perceived legitimacy affect how we choose to proceed. What can we conclude from what we heard? Strategic Purchasing Narrowly understood, strategic purchasing can be considered synonymous with prudent buying: getting good value for money, specifying with some precision the terms of a transaction, managing risks and negotiating good prices. In effect, it shifts the argument from who should finance care (Figueras et al. 2005; Marchildon et al. 2004; Mossialos et al. 2002) to who should deliver it (Deber 2004). Strategic purchasing also entails addressing the incentives inherent in various payment mechanisms. As the symposium’s speakers clarified, these considerations, in turn, involve Thoughts on the Day: Strategic Purchasing and Equity