Benefit Package Design for Universal Health Coverage

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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 organized 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 a direct implication 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.

In response to multiple requests voiced across continents, the objectives of the global exchange series are:

1. Provide a peer-to-peer platform for policymakers and practitioners to share experiences on decision making for their benefit packages.
2. Specifically discuss challenges and transmit international best practices related to

Governance: Key system functions, mandates and interactions
Process: the flow from regulatory, to scientific reviews, economic analysis and health technology assessments (HTA), pricing negotiations, costing/adjusting of reimbursement tariffs, monitoring of usage
Linkage to Provider Payment system and overall financial sustainability control

3. Co-produce knowledge products and hands-on tools which can be adapted to specific country contexts.

The GIZ program "Global Alliances for Social Protection" of German Development Cooperation promotes dialogue and exchange of learning about social protection among emerging and interested countries in Latin America, Asia and Africa.

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Viktoria Rabovskaja

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