Strategic Health Purchasing & Provider Payment Training Course

Course Overview

Learning Objectives

• By the end of this training course, participants will be able to:
• Explain the role of strategic purchasing within universal health coverage.
• Distinguish active strategic purchasing from passive budget allocation and claims reimbursement.
• Analyze purchaser governance, mandates and the separation of purchaser and provider roles.
• Design an explicit benefit package aligned with available funds and population needs.
• Apply priority-setting criteria and health technology assessment evidence to coverage decisions.
• Estimate the cost and budget impact of benefit package options.
• Compare budgets, fee-for-service, fee schedules, capitation, per diem and case-based payment.
• Assess the incentives and financial risks that each provider payment mechanism creates.
• Develop capitation rates with appropriate risk adjustment and enrollment rules.
• Structure case-based payment using diagnosis-related groups, case weights and base rates.
• Design performance-based payment indicators, targets and verification arrangements.
• Prepare provider contracts with clear service, quality, reporting and payment terms.
• Establish purchaser accountability, monitoring and public reporting arrangements.
• Develop a phased provider payment reform and strategic purchasing roadmap.

Who Should Attend

Learning Outcomes

• Upon completion of the course, participants will be able to:
• Map how revenue collection, pooling and purchasing interact in their health system.
• Assess current purchasing practices against strategic purchasing principles.
• Define the purchaser's legal mandate, decision rights and relationship with providers.
• Draft benefit package inclusion and exclusion criteria with transparent revision rules.
• Use costing and budget impact estimates to test the affordability of coverage choices.
• Select a provider payment mix suited to each level of care.
• Calculate a basic risk-adjusted capitation rate for a primary care network.
• Explain how case weights and base rates determine hospital payments.
• Identify upcoding, cost shifting and under-provision risks in payment design.
• Design a pay-for-performance scheme with measurable, verifiable indicators.
• Prepare a contracting and empanelment framework for public and private providers.
• Build a purchaser dashboard covering coverage, quality, cost and financial protection.
• Communicate payment reform proposals to ministries, providers and members.
• Prepare a sequenced strategic purchasing implementation plan.

Course Outline