Benefit Package

All societies define, implicitly or explicitly, through the Benefit Package, the health services covered by mandatory contributory or government funded health insurance, or the health services guaranteed by the state.  Although many developed and developing countries do not have explicit Benefit Packages, there is an increasing trend to make Benefit Packages more explicit and/or to enact guaranteed Benefit Packages. The evidence on the explicit Benefit Package’s net impact on health access is still evolving. Initial evidence suggests that they are increasingly effective in helping populations demand compliance from general commitments that are difficult to enforce in the absence of a clear package. The Benefit Package policy debate is particularly critical for operationalizing the concrete meaning of Universal Health Coverage in developing countries.
 
An explicit Benefit Package has substantial equity, financial, fiscal, operational, regulatory, and health implications, which can be made more acute when they are enacting guaranteed or legally binding. In view of these implications, policy makers and systems leaders should follow at least three stages in the Benefit Package process: a) Benefit Package Policy dialogue with wide stakeholder engagement; b) Design the Package in detail including its implementation strategy and impact assessment; c) Implement it operationally including regulatory and enforcement actions. Each of these stages in general needs to follow careful technical, policy, and political steps.
 
CHD members have significant experience in advising policy makers and system leaders in all of the above three stages of Benefit Package design and implementation.

Policy
​Design

Launching a policy dialog and policy process is the first step in the formulation of introducing a Benefit Package. The international experience shows that this initial stage is critical as the introduction of a Benefit Package is far from being a technical decision alone and has substantial policy and political implications.
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Key issues to address should include, among others:
  • What are the objectives of the policy and what is success?
  • Explicit or implicit package?
  • Mandatory for all or groups of the population?
  • What criteria will be used for deciding the composition of the package?
  • Who designs it, who approves the first package and what is the governance to update it?

Package and Operational Design

Once there is a policy and political decision to move forward with an explicit Benefit Package, a detail design follows. The design process is in reality an iterative process that should address at least:
  • What specific criteria will be use to define what is included?
  • What are the services included?
  • Under what conditions?
  • What are the financial, fiscal, operational, equity, health, satisfaction, and financial protection implication?
  • What adjustments are needed due to the implications?
  • What is the implementation strategy?
  • Detailed governance arrangements for enforcement of entitlements, provider and insurer compliance, monitor impact and review and update of the package, complain and conflict resolution.

Implementation and Updates

Once the Benefit Package has been fully designed in its first version, including its operational design, policy makers need, among others:

  • Launch information, communication, and engagement campaigns with key stakeholders including patients,  health workers, judiciary system, journalists, the general public, etc.
  • Pilot test key operational design systems such as provider and insurer compliance systems, patient information and complain resolution, funding mechanisms (if any different to existing).
  • Launch the key regulatory systems (reporting from insurers and providers; operational regulations, etc)
  • Monitoring of impact and operational definitions of the package as regulatory adjust them.
  • Launch the governance arrangement (commission, group) for decisions to adjust the package, including future  growth.
  • Impact evaluation of the Benefit Package on access to health care, financial protection, patient satisfaction and long term sustainability.
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