Countries that are dedicated to achieving universal health coverage want a scheme that covers all individuals, but covering a full suite of medical services for the entire population is often impractical and would exceed available resources. Tradeoffs are inherent in all coverage schemes, including which services to cover, which populations to cover, and how much covered individuals should pay out of pocket for services.
Given the limitations on resources for countries, the design of the health benefits package must take into account the financial, technical, and economic capabilities of the country’s health system. Failure to account for country capacity can lead to implicit rationing that does not align with country priorities. Not only should the benefits package be scaled to available resources and capacities, but the health system that implements the package should be coordinated in a way that enables covered services to be accessed by beneficiaries – either through providers or through public health interventions. These coordinating policies or regulations are what we refer to as "health benefits policies".
- The Primary Care Benefits Policy Framework: This document briefly outlines the JLN’s approach to designing and revising health benefits policies. This framework was used to create Designing Health Benefits Policies: A Country Assessment Guide.
- Designing Health Benefits Policies: Lessons from Six JLN Countries: This report synthesizes lessons and insights from a series of country assessments evaluating efforts to implement a new or revised benefits package within a comprehensive health benefits policy. The report outlines the framework developed by the JLN Health Benefits Policy (HBP) Collaborative for applying global best practices when creating and implementing a health benefits package.
- Designing Health Benefits Policies: Country Assessments from Indonesia, Kenya, Malaysia, Mali, Morocco, and Vietnam: The assessments document the UHC strengthening policies that were put in place to support the implementation of new or reformed benefits packages.
- Designing Health Benefits Policies: A Country Assessment Guide: This jointly produced and piloted assessment guide, developed by the six countries listed above, guides countries in prioritizing and thinking through the complex web of decisions that must be considered when developing, implementing or reforming a benefits package within a comprehensive health benefits policy. (Guide is also accessible through the Download button below)