Table 1

Theory of change: how health services packages might generate financing for UHC

Health financing core functionPathway and country examples
Resource mobilisation
  • Capacity to advocate for health taxes (South Africa, Mexico, Philippines, Morocco)

  • Identification of public/common goods for health (Iran)

  • Improved dialogue with public finance authorities (Mexico, Pakistan)

  • Coverage alignment on breadth and depth across funds (India)

  • Equalisation of public subsidy between groups (Thailand)

  • Addressing funding gaps of programmes (Indonesia)

  • Targeting the poor for inclusion to the same coverage scheme (South Africa, India)

  • Explicit complementarity of different revenue sources for the package (Kyrgyzstan)

  • Introduction of marginal cost insurance programmes, combining supply side financing from the budget (eg, for salaries) with output-based payment by an explicit purchasing agency (Thailand Universal Coverage Scheme)

Strategic purchasing
  • Allocative efficiency through priority setting (mostly Cost Effectiveness Analysis) and establishing a HTA agency/practice (France, Lebanon, Norway, UK, Tunisia, India)

  • Technical efficiency through costing exercises, improved collaboration between public and private sectors, integration of financing through levels of care and/or identification of provider payment mechanisms that can improve linkages between pooling and service delivery of explicit benefits (France, Thailand)

  • HTA, health technology assessment; UHC, universal health coverage.