Table 4. Contributing factors and undermining factors of purchasing functions.

	Contributing factors	Undermining factors
A. Legal framework	Clear policy, expectation and mandate of “a purchaser” for benefit of people and health system; NHSO has only one mandate of managing UCS.	Clear policy of not operating as a purchaser but merely a payer, responsible for financial transactions; CSMBS in one among sixteen mandates of CGD. Therefore CGD has many other important tasks including advice on financial management, public procurement in the organization.
B. Governing body, organization and accountability framework	An independent organization; Governing body of multi-stakeholders–citizens’ engagement; Adequate number and competency of staff (including many with health background).	Government structure with rigid mandate using command and control; Inadequate staff; Staff do not have health background.
C. Resource	Tight budget with tough process of negotiation resulting in careful management.	Soft budget constraint leads to inefficiency of the system.
D. Information	Information management; Using appropriate information, communication and technology; Pool of information from all contracted providers to the national level.	Fragmented data requirement of different schemes creates difficulties for providers.
E. Communication	Two way communication; Proactive communication–NHSO staff visited providers; NHSO conducts public hearing with citizens.	Official process of bureaucratic channels is ineffective.
F. Audit	Independent auditing mechanism; Team work of audit; An opportunity to improve knowledge and skill of the audit team and providers and to improve data quality of providers; Penalty and incentives must be implemented.	Negative attitude, perception and practice of investigators and being investigated persons.

Source: Authors’ synthesis