Article Text

Download PDFPDF
Purchaser strategies to influence quality of care: from rhetoric to global applications
  1. P McNamara
  1. Correspondence to:
 P McNamara
 Senior Policy Analyst, Center for Delivery, Organization and Markets, US Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA; pmcnamar{at}


The potential of purchasers to influence the quality and safety of care has captured the attention of health sector leaders worldwide. Quality based purchasing explicitly seeks to hold providers accountable for the quality and safety of care. Three strategies are available to purchasers: (1) selective contracting based on quality; (2) payment differentials based on quality; and (3) sponsorship of comparative provider report cards. Examples are given to illustrate each of the three strategies. Governments, employers, social insurance funds, community based insurance organizations, health plans, donors, and other buyers of health services are encouraged to explore and debate these purchaser strategies within the context of an overarching national or local quality framework. Public and private funders of operations research are encouraged to support and disseminate evaluations of purchaser efforts to improve quality. This paper is designed to highlight and frame purchasers’ strategies explicitly crafted to enhance the quality and safety of care. The ultimate aim is to encourage thoughtful discussion about whether or not one or more purchaser strategy might support a particular country’s goals to improve care. Experiences from both developed and developing countries are included to facilitate the exchange of ideas and provide the broadest of perspectives.

  • purchaser strategies
  • quality based purchasing
  • performance based purchasing

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Competing interests: none declared.

  • The views expressed in this paper are those of the author and do not necessarily reflect those of the Agency for Healthcare Research and Quality (AHRQ).