Benefit Package Design for Universal Health Coverage: A framework for systematic decision making on pharmaceuticals, country experiences and global best practices

This week’s webinar, titled Benefit Package Design for Universal Health Coverage: A framework for systematic decision making on pharmaceuticals, country experiences and global best practices, was hosted by socialprotection.org on 26 October, 2017. The event was organised by German Development Cooperation through the programme Global Alliances for Social Protection, implemented by Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ).

The event was moderated by Viktoria Rabovskaja, (GIZ Global Alliances for Social Protection), alongside panelist, Ioana Ursu, (PharmMD, former Secretary of State in Romania and Director of Mapping Health Ltd).

The recording is available here and the presentation here.

Many emerging and developing countries currently engage in reforms aiming at better financial protection of their population through universal health coverage (UHC). Reforming the way national health care is organised and financed has profound implications for equity. Moreover, we know that health-related financial shocks are one of the major causes for the impoverishment of vulnerable population groups. Preventing such shocks has a direct effect on poverty prevention and alleviation.

National systems providing public services, no matter rich or poor, are always under budget constraint resulting in the dilemma to balance financial protection of patients versus financial sustainability of national health funds. Therefore, it is critical to manage the cost of healthcare provision and ensure the most efficient spending of the scarce resources.

Consequently, a carefully established Benefit Package is key to ensure service access for patients. Equally, decisions about size and depth of benefits have direct implications on the financial sustainability of UHC schemes.

Policy makers are required to make systematic decisions in view of balancing treatment benefits and the cost. Many countries striving for UHC face the challenge to establish a transparent and efficient decision-making process which in turn creates large inefficiencies and access barriers to patients.

Globally there are however systematic best practices emerging to handle the respective challenges. Several countries have developed tools and methods which provide great improvements in terms of resources and service access. What is lacking so far, is an exchange of those emerging solutions around the globe which could help countries to benefit from each other, avoid mistakes and progress faster with their national systems.

Ursu began by emphasizing the value of peer-to-peer platform for policymakers and practitioners to share experiences on decision making for their benefit packages. Specifically, discussing challenges and transmitting international best practices. There is a need to co-produce knowledge products and hands-on tools which can be adapted to specific country contexts. Accordingly, she highlighted that the goal of the presentation was to support further knowledge exchange, based on the feedback provided by the audience.

Ursu then went on to point out the main features of a Benefit Package. The patterned realities of financing universal health coverage were discussed, which include four main components:

  1. Services
  2. Medicines
  3. Public health programmes
  4. Infrastructure

It was emphasized that a systematic approach is needed when identifying the potential flaws in creating a sustainable benefit package for UHC. Regarding access to medicines and the sustainability of the (newly created) health insurance system, the general trend is setting up or reforming the health technology assessment (HTA) unit. When evaluating UHC systems across the world, the pattern of data and processes suggests a more systematic and detailed approach is required, in order to reach a balance between needs, local capacity and national political priorities.

Some of the mandatory functions of the pharmaceutical reimbursement system were described:

  1. Regulatory function
  2. Scientific/expert review
  3. Pharma economics/Health Technology Assessment Function
  4. Pricing and reimbursement decision-making
  5. Purchasing and payment
  6. Monitoring, control and feedback function

It should be considered that while the functions remained the same, the number of institutions fulfilling those functions varies in each country, and tends to reflect cultural and political choices. Some key examples are France, Russia, the United States and the Philippines.

When all functions are present, a well-defined flow of information between the functions is needed to ensure optimal decision-making efficiency. In an ideal system, the flow of information between pharmaceutical functions is well defined, and has a clear pathway, starting from the regulatory function and ending with the monitoring and feedback function.

Finally, an analysis about the inputs and outputs related to the process and data integration necessary to delivering a benefits package was presented, which is crucial to support more informed decision-making.

The webinar closed with Rabovskaja moderating the Q&A session:

  • How would the Ministry of Finance support a pricing policy in a country?
  • Is a health information system a pre-requisite for monitoring and evaluation? If not, how could it be done?
  • What technical capacities are needed to be built within these institutions to collect and derive value from all this data?
  • Which countries (besides the USA) has a HTA function as a role assigned to the health insurance institution?

Watch the video here!

 

This blog post is published as part of the Webinar Series, which brings together the summaries of webinars organised by socialprotection.org and partners on a variety of themes related to social protection. If you have any thoughts on the topic discussed, we would love to hear them. Please add your comments below and we will get back to you.

Social Protection Programmes: 
  • Social insurance
    • General
    • Health insurance
Social Protection Topics: 
  • Coverage
Cross-Cutting Areas: 
  • Health
    • General
  • Human capital
  • Human rights
  • Inequality
  • Resilience
  • Social inclusion
Countries: 
  • Global
Regions: 
  • Global
The views presented here are the author's and not socialprotection.org's