Active Purchasing: Empirical Insights from the Dutch Healthcare System and Lessons for Low- and Middle-Income Countries; Comment on "Measuring Active Purchasing in Healthcare: Analysing Reallocations of Funds Between Providers to Evaluate Purchasing Systems Performance in the Netherlands"

Stadhouders et al. critically examines the assumptions behind managed competition, revealing that competitive systems alone may not drive efficiency gains through fund reallocation. Their findings from the Dutch hospital sector suggest limited or low reallocation of funds between providers and highlight the need for monitoring resource allocation progress, understanding barriers and adjusting incentives for better functioning healthcare markets. For LMICs undergoing health reforms, the Dutch experience underscores the importance of tailoring purchasing models to local contexts. LMICs should enhance data use for more strategic decision-making as well as building regulatory framework and institutional capacity for stronger implementation. Future research should explore how purchasing models interact with diverse health system characteristics to inform system-specific reforms.