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