Introduction The provision of a comprehensive health benefit package is a critical step for countries on their path to universal health coverage. Designing the benefit package requires answering questions around what services are funded, which sections of the population are to be covered, to what extent are interventions covered financially, and what are the exclusion criteria. The objective of this work is to present results of a 2020/21 WHO survey highlighting the coverage of potentially non-cost-effective interventions in country health benefit packages. This provides information on coverage boundaries and for highlighting where potential efficiency gains may lie.
Methods A global survey was conducted by WHO in 2020/2021 and coordinated through WHO regional and country offices with respondents frequently collaborating with members of relevant national/subnational health insurance/benefit package organizations. Health benefit package information was answered for a country’s largest public-sector-financed benefit package. To develop the survey, relevant experts in health category areas at WHO were consulted to identify four proxy interventions ranging from simplest and least resource intensive to most complex and most resource intensive and covered 37 different intervention categories. The data was analyzed descriptively to evaluate coverage patterns among countries from different geographic regions, income groups and arrangement of health financing schemes.
Results The results provide a detailed picture of the nature of benefit packages with regards to the inclusion of interventions that can be considered non-cost effective. We also observe a preliminary gradient of coverage with fewer lower-middle-and low-income countries reporting inclusion of high-cost interventions in their benefit package. This work seeks to fill the gaps in the knowledge base, and highlight country-specific coverage decisions regarding the inclusion of non-cost-effective services, with an implication for affordability. Future work should understand how the affordability and other criteria link with decision-making, which can help countries design packages for UHC.
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