[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-detail-113477-en":3,"doc-seo-113477-105":31,"detail-sidebar-cat-0-en-105":92},{"code":4,"msg":5,"data":6},0,"success",{"doc_id":7,"user_id":8,"nickname":9,"user_avatar":10,"doc_module":4,"category_id":11,"category_name":12,"doc_title":13,"doc_description":14,"doc_content":15,"file_id":16,"file_url":17,"file_type":18,"file_size":19,"view_count":20,"is_deleted":4,"is_public":21,"is_downloadable":21,"audit_status":21,"page_count":22,"language":23,"language_code":24,"site_id":25,"html_lang":24,"table_of_contents":26,"faqs":27,"seo_title":28,"seo_description":14,"update_tm":29,"read_time":30},113477,13056703019662,"Evangeline","https://ap-avatar.wpscdn.com/avatar/be000253a8e92610077?_k=1778726343310543188",7,"Healthcare","Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia","This paper examines how purchasing decisions in Armenia may shape barriers to using high-quality health care, with a focus on non-communicable diseases. Using a literature review and key informant interviews, it applies the strategic health purchasing progress framework to assess how purchasing characteristics, system factors, and the political, administrative, and macro-fiscal context enable or hinder service delivery goals. The study ends with six reform lessons to improve coverage and quality.","Health Systems & Reform  \nISSN: (Print) (Online) Journal homepage: [https://www.tandfonline.com/loi/khsr20](https://www.tandfonline.com/loi/khsr20)  \nChallenges and Opportunities for Purchasing HighQuality Health Care: Lessons from Armenia  \nAdanna Chukwuma, Hratchia Lylozian & Estelle Gong  \nTo cite this article: Adanna Chukwuma, Hratchia Lylozian & Estelle Gong (2021) Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia, Health Systems &  \nReform, 7:1, e1898186, DOI: 10. 1080/23288604 .2021.1898186  \nTo link to this article: [https://doi.org/10.1080/23288604.2021.1898186](https://doi.org/10.1080/23288604.2021.1898186)  \n© 2021 The Author(s) . Published with license by Taylor & Francis Group, LLC.  \n Published online: 29 Apr 2021.  \nDisclosure Authorized Public Disclosure Authorized  \nPublic  \n Submit your article to this journal   \n\n|  Article views: 92 |\n| --- |\n|  View related articles  |\n|  View Crossmark data |\n\nFull Terms & Conditions of access and use can be found at [https://www.tandfonline.com/action/journalInformation?journalCode=khsr20](https://www.tandfonline.com/action/journalInformation?journalCode=khsr20)  \nHEALTH SYSTEMS & REFORM  \n2021, VOL. 7, NO. 1, e1898186 (10 pages) [https://doi.org/10.1080/23288604.2021.1898186](https://doi.org/10.1080/23288604.2021.1898186)  \nRESEARCH ARTICLE     \nChallenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia  \nAdanna Chukwuma a, Hratchia Lyloziana, and Estelle Gongb  \naHealth, Nutrition, and Population Global Practice, World Bank Group, Washington, DC, USA; bMount Sinai Health System, New York, New York, USA  \nABSTRACT  \nThis paper examines how purchasing decisions in Armenia may contribute to barriers in using highquality health care, particularly for non-communicable diseases, drawing on a review of the literature and key informant interviews. The paper adapts the strategic health purchasing progress framework, to examine how characteristics of purchasing, the health system, and the political, administrative, and macro-fiscal environment may have facilitated or hindered the attainment of service delivery goals. We conclude with six lessons for reforms aimed at improving the coverage and quality of health care in Armenia. First, increasing the political priority of access to quality of health care is a pre-requisite to advancing reforms to address these issues. Second, improved purchasing governance in Armenia will require a purchaser that can make decisions without political interference, with appropriate accountability mechanisms, improvements in technical capacity, and the routine use of data systems. Third, there is a need for the regulatory framework to ensure that revisions of the benefits package contribute to reducing the disease burden and improving access to care. Fourth, regulations governing quality-related criteria for provider selection should be enforced and include considerations for process quality. Fifth, payment incentives should be revised to encourage an increase in the supply of primary health care, reduce bypassing for hospital care, and improve the quality of services. Sixth, the potential of purchasing to improve service delivery will be dependent on increased pre-paid and pooled funds and better governance of the quality of care.  \nARTICLE HISTORY  \nReceived 12 October 2020 Revised 9 December 2020 Accepted 26 February 2021  \nKEYWORDS  \nStrategic purchasing; primary health care; universal health coverage; quality; Armenia  \nIntroduction  \nPurchasing, which involves decisions on the allocation of health financing for services, is an important policy lever for addressing challenges with access to and quality of care. 1 Purchasing policy defines what services are paid for, who receives payment, and how payment is made, affects provider and user behavior, and thus, health care access and quality. To improve population health in Armenia, there is a need to increase access to and qua","cbCaifpEqzjAy5XG","https://ap.wps.com/l/cbCaifpEqzjAy5XG","pdf",690437,4,1,11,"English","en",105,"# Abstract\n# Introduction\n## Purchasing as a policy lever for access and quality\n## Health indicators and the growing burden of NCDs\n## Access constraints in primary health care\n# Reform lessons for improving coverage and quality","[{\"question\":\"What does the paper study about Armenia’s health purchasing?\",\"answer\":\"It evaluates how purchasing decisions can contribute to barriers in accessing high-quality care, especially for non-communicable diseases, using literature review and key informant interviews.\"},{\"question\":\"How does the paper analyze factors behind service delivery outcomes?\",\"answer\":\"It adapts the strategic health purchasing progress framework to examine how purchasing characteristics, system features, and the political, administrative, and macro-fiscal environment enable or hinder service delivery goals.\"},{\"question\":\"What are the six core lessons for reform highlighted in the paper?\",\"answer\":\"They include raising political priority for access to quality care, strengthening purchasing governance and accountability, aligning the benefits package with disease-burden reduction, enforcing quality-related provider selection regulations, revising payment incentives to improve primary care supply and service quality, and increasing pre-paid pooled funds with stronger governance of care quality.\"}]","Challenges and Opportunities for Purchasing High-Quality Health Care: Lessons from Armenia | 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does the paper study about Armenia’s health purchasing?","Question",{"text":76,"@type":77},"It evaluates how purchasing decisions can contribute to barriers in accessing high-quality care, especially for non-communicable diseases, using literature review and key informant interviews.","Answer",{"name":79,"@type":74,"acceptedAnswer":80},"How does the paper analyze factors behind service delivery outcomes?",{"text":81,"@type":77},"It adapts the strategic health purchasing progress framework to examine how purchasing characteristics, system features, and the political, administrative, and macro-fiscal environment enable or hinder service delivery goals.",{"name":83,"@type":74,"acceptedAnswer":84},"What are the six core lessons for reform highlighted in the paper?",{"text":85,"@type":77},"They include raising political priority for access to quality care, strengthening purchasing governance and accountability, aligning the benefits package with disease-burden reduction, enforcing 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