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180:oral Designing health benefit packages for universal health coverage – should countries follow a sectoral, incremental or hybrid approach?
  1. Rob Baltussen1,
  2. Gavin Surgey1,
  3. Anna Vassall2,
  4. Ole F Norheim3,
  5. Kalipso Chalkidou4,5,
  6. Sameen Siddiqi6,
  7. Mojtiba Nouhi7,8,
  8. Sitaporn Youngkong9,
  9. Maarten Jansen1,
  10. Leon Bijlmakers1,
  11. Wija Oortwijn1
  1. 1Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3University of Bergen, Bergen, Norway
  4. 4The Global Fund, Geneva, Switzerland
  5. 5Imperial College, London, UK
  6. 6Aga Khan University, Karachi, Pakistan
  7. 7Ministry of Health and Medical Education, Tehran, Iran
  8. 8Tehran University of Medical Sciences, Tehran, Iran
  9. 9Mahidol University, Bangkok, Thailand


Countries around the world are increasingly rethinking the design of their health benefit package to achieve universal health coverage. Countries can periodically revise their packages by performing sectoral analyses, i.e. by evaluating a broad set of services against a ‘doing nothing’ scenario using a budget constraint. Alternatively, they can carry out incremental analyses, i.e. to evaluate specific services against current practice using a cost-effectiveness threshold. In addition, countries may employ hybrid approaches. This paper compares these approaches in terms of the nature of allocative inefficiencies, quality of analysis, political feasibility of reallocation decisions, and integrated health system analysis. Sectoral analysis is especially suited in contexts with large allocative inefficiencies in current service provision and can, in theory, realize large efficiency gains. However, it may be challenging to implement a comprehensive redesign of the package in practice. Incremental analysis is especially relevant in contexts where specific new services raise challenges to the allocative efficiency and sustainability of the health system. It may potentially support efficiency improvement, but its focus has typically been on new services while existing inefficiencies remain unchallenged. The use of hybrid approach may be a way forward to address the strengths and weaknesses of sectoral and incremental analysis.

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