世界银行-疫情中的采购：亚美尼亚和罗马尼亚卫生系统应对的经验教训（英）-2023-54页_1mb

PURCHASING IN A PANDEMIC: Lessons from Health Systems Response in Armenia and Romania

This report examines adjustments to health purchasing arrangements in Armenia and Romania during the COVID-19 pandemic using mixed methods: scoping literature review, key informant interviews, and quantitative health system indicator analysis.

Key findings include:

1. Both countries shifted toward strategic purchasing with increased central coordination and expanded benefits packages to cover COVID-19 services universally.
2. Payment mechanisms evolved from fee-for-service to more comprehensive reimbursement in Romania and case-based payments in Armenia.
3. Governance strengthened through centralized procurement led by ministries of health, though stakeholder consultation was limited.
4. Innovation accelerated, particularly telemedicine, but adoption was inconsistent between countries and service levels.

Health system outcomes showed mixed results: improved financial risk protection but disruptions to routine services and variable changes in mortality. Both countries demonstrated agility in adapting purchasing to crisis needs while highlighting challenges for sustainable longer-term reforms.

The report concludes that:

• Effective pandemic purchasing requires intergovernmental cooperation, agile tools, and innovation.
• Lessons apply beyond these contexts for improving crisis responsiveness.
• Further research is needed on sustainability and causal impacts of specific purchasing changes.

Limitations: Data fragmentation constrained analysis, and findings may not generalize beyond these contexts due to country-specific factors.