Background and Objective:
Chronic disorders adversely affect the quality of life of patients living with illnesses and create a substantial financial burden. We aimed to assess how purchasing agreements have been used to promote quality in chronic disease care and understand its role in promoting quality of chronic disease care.

Methods:
We searched for research studies published over the past 10 years in nine electronic databases in English, Chinese, French, and Spanish languages, supplement by grey literature searches and reviews of reference lists. We identified key characteristics of these arrangements and conducted narrative syntheses of the barriers and enablers to implementation.

Results:
We retrieved 6486 records. Of them, 88 studies (80 quantitative and eight qualitative studies) met our eligibility criteria. They were predominantly from high income countries with the main payment method being pay for performance. The purchasing arrangements were generally set within national insurance or government funded programs. Quality of care was generally measured in terms of intermediate health outcomes, processes and efficiency. Adverse selection (‘cherry-picking’ of patients) was observed in some studies resulting in bias against socioeconomically disadvantaged and high-risk groups. The main barriers/enablers reported were the cultural shifts required to transition from a funding organisation into one with a purchasing role, added investment in infrastructure and training required to enable purchasing, and the need to engage patients and other stakeholders.

Conclusions:
Evidence majorly from high income settings suggested pay for performance arrangement as one of the widely used strategic purchasing as a means of improving quality outcomes in chronic disease management. There is a need to address adverse selection and work towards improving the quality aspect.