Resources are always finite—the evidence-based, fair, transparent, and accountable benefits ...

398 Pages·2017·15.58 MB·English

Praise for
What’s In, What’s Out: Designing Benefits for Universal Health Coverage
“Resources are always finite—the evidence-based, fair, transparent, and
accountable benefits package is the most important tool to justify the use of
finite resources to achieve real universal health coverage.”
—Suwit Wibulpolprasert, Ministry of Public Health, Thailand
“A wonderful book that breaks down the most complex of challenges into a
format accessible to economists, social scientists, and policymakers alike—
a must-read for those working to achieve universal health coverage.”
—Soumya Swaminathan, Director, Indian Council of Medical Research
“Universal health coverage globally is an inspiring idea, but it needs to be a
practical one too. This book offers invaluable insights from around the world,
both into how to design high-quality, equitable, and affordable packages of care,
but also, and as importantly, how to implement them.”
—Lord Nigel Crisp, former Chief Executive, NHS England
“This book addresses an important concern: which services can we provide and
which can we not, given limited health resources? Because the answer is context-
dependent, we need principles and methods for deciding what we should and
should not cover with public monies.”
—Wei Fu, Director General, China National
Health Development Research Center
“Many policymakers emphasize ‘who is covered’ when they talk about universal
health coverage. However, the second dimension, namely ‘what is covered,’
deserves as much attention, as this book successfully argues. It also gives
practical advice on who should be involved, what to consider, and how we can
achieve it.”
—Reinhard Busse, Professor of Health Care Management,
Technische Universität Berlin
“This timely publication provides the critical analysis and concrete strategies
required by health leaders to design fair and far-reaching health benefit packages
that are crucial to achieving universal health coverage and SDG3, and to
transforming political promises into people-centered healthcare.”
—Felicia Knaul, Director, Institute for Advanced Study
of the Americas, University of Miami
“One of the big challenges for universal health coverage in Latin America and the
Caribbean is the difference between what is being promised and what is actually
delivered, what people may expect and what they actually get. Health benefits
packages, by making explicit what is implicit, become critically important in
this context.”
—Adolfo Rubinstein, Founder and Director General,
Institute of Clinical Effectiveness and Health Policy (IECS), and Director,
Center of Excellence in Cardiovascular Health for South America of IECS
“What’s In, What’s Out: Designing Benefits for Universal Health Coverage
provides accessible and thorough guidance on the main policy issues related to
health benefit packages. This book is a must-read for health policymakers and
practitioners seeking to develop a roadmap towards universal health coverage
while enhancing the health system’s efficiency, equity, transparency, and
sustainability.”
—Midori de Habich, former Minister of Health, Peru
WHAT’S IN, WHAT’S OUT?

WHAT’S IN,
WHAT’S OUT?
Designing Benefits for Universal Health Coverage
Edited by
Amanda Glassman,
Ursula Giedion and
Peter C. Smith
Copyright © 2017
center for global development
2055 L St. NW
Washington DC 20036
www.cgdev.org
All rights reserved. No part of this publication may be repro-
duced or transmitted in any form or by any means without per-
mission in writing from the Center for Global Development.
Library of Congress Cataloging-in-Publication Data
Names: Glassman, Amanda, 1970– editor. | Giedion, Ursula,
editor. | Smith, Peter (Peter C.), editor. | Center for Global
Development, issuing body.
Title: What's in, what's out : designing benefits for universal
health coverage / edited by Amanda Glassman, Ursula Gie-
dion, and Peter C. Smith.
Description: Washington DC : Center For Global Develop-
ment, [2017] | Includes bibliographical references and index.
Identifiers: LCCN 2017019856 (print) | LCCN 2017021073
(ebook) | ISBN 9781944691059 | ISBN 9781933286891
(pbk.)
Subjects: | MESH: Universal Coverage—economics | Insurance
Benefits—economics | Universal Coverage—ethics | Insur-
ance Benefits—ethics | Cost-Benefit Analysis
Classification: LCC RA412 (ebook) | LCC RA412 (print) |
NLM W 225.1 | DDC 368.4/2—dc23
LC record available at https://lccn.loc.gov/2017019856
9 8 7 6 5 4 3 2 1
CONTENTS
Foreword ix
Lord Darzi of Denham and Kalipso Chalkidou
Acknowledgments xi
Preface xiii
About This Book xv
INTRODUCTION The Health Benefits Package:
Bringing Universal Health Coverage from Rhetoric to Reality 1
Amanda Glassman, Ursula Giedion, and Peter C. Smith
Policymaker Commentary
Revisiting and Reformulating: How Explicit Benefit Packages
Have Helped Mexico Move toward Universal Health Coverage 19
Eduardo González-Pier
PART I
GOVERNANCE AND PROCESS
The Foundation of a Health Benefits Package Policy
Introduction 23
Ursula Giedion
1 Defining the Rules of the Game: Good Governance Principles
for the Design and Revision of the Health Benefits Package 30
Ursula Giedion and Javier Guzmán
2 Tracking the Benefits Package from Paper to Practice: Monitoring and Evaluation 61
Ricardo Bitrán
3 Managing the Money: Fiscal and Budgetary Considerations for the Benefits Package 88
Amanda Glassman
Policymaker Commentary
Aspiring to National Health Insurance, South Africa Considers Its Benefits Package 105
Mark Blecher and Yogan Pillay
vi Contents
PART II
PUTTING PEN TO PAPER
Methods to Select a Benefits Plan That Works
Introduction 109
Peter Smith
4 How Much Health for the Money? Using Cost-Effectiveness
Analysis to Support Benefits Plan Decisions 115
Mark Sculpher, Paul Revill, Jessica M. Ochalek, and Karl Claxton
5 Benefits beyond Health: Evaluating Financial Risk Protection
and Equity through Extended Cost-Effectiveness Analysis 141
Stéphane Verguet and Dean T. Jamison
6 Comparing Apples and Oranges: Strategies to Weigh Health against Other Social Values 154
Alec Morton and Jeremy A. Lauer
7 Square Pegs, Round Holes: Addressing Health Sector Interventions
with Non-Health Benefits 175
Rachel Silverman
8 At What Price? Costing the Health Benefits Package 185
Cheryl Cashin and Annette Özaltın
9 Beyond Cost Effectiveness: Health Systems Constraints to
Delivery of a Health Benefits Package 201
Katharina Hauck, Ranjeeta Thomas, and Peter C. Smith
10 See the Bigger Picture: Resource Optimization Tools to Inform HBP Design 214
Marelize Görgens, Janka Petravic, David J. Wilson, and David P. Wilson
11 Reliable Sources? Generating, Selecting, and Applying
Evidence to Inform the Health Benefits Package 235
Neil Hawkins, Robert Heggie, and Olivia Wu
Policymaker Commentary
Confronting Tight Fiscal, Human Resource, and Evidence
Constraints, Malawi Revises Its Benefits Package 247
Gerald Manthalu, Dominic Nkhoma, Jessica M. Ochalek, Andrew Phillips, and Paul Revill
Policymaker Commentary
More than a List: Reforming a Country’s Health Benefits Package—
A Rigorous Approach to Tackling Costly Overutilization 253
Yot Teerawattananon, Waranya Rattanavipapong, Benjarin Santatiwongchai,
Thanaporn Bussabawalai, Kittiphong Thiboonboon, and Saudamini Dabak
Policymaker Commentary
Starting with the Essential Medicines List: How New Zealand’s
PHARMAC Prioritizes and Purchases Pharmaceutical Benefits 268
Thomas Wilkinson
Contents vii
PART III
TOUGH CHOICES
Considering Ethics, Rights, and Political Economy in Defining Benefits
Introduction 273
Amanda Glassman
12 Priority-Setting as Politics: A Political Economy Framework
for Analyzing Health Benefits Package Decisions 277
Jesse B. Bump and Angela Y. Chang
13 A Matter of Morality: Embedding Ethics and Equity in the Health Benefits Policy 290
Carleigh Krubiner and Ruth Faden
14 The Right to Health and the Health Benefits Package:
Accounting for a Legal Right to Health When Designing a HBP 327
Rebecca Dittrich, Leonardo Cubillos, Lawrence Gostin, Kalipso Chalkidou, and Ryan Li
Policymaker Commentary
Chile’s Guaranteed Package of Health Benefits Navigates Political Challenges 345
Antonio Infante
Additional Resources 349
Contributors 355
Glossary 363
Index 367