What’s In, What’s Out: Designing Benefits for Universal Health Coverage

Vaccinate children against deadly pneumococcal disease, or pay for cardiac patients to undergo lifesaving surgery? Cover the costs of dialysis for kidney patients, or channel the money toward preventing the conditions that lead to renal failure in the first place? Policymakers dealing with the realities of limited health care budgets face tough decisions like these regularly. And for many individuals, their personal health care choices are equally stark: paying for medical treatment could push them into poverty.

Many low- and middle-income countries now aspire to universal health coverage, where governments ensure that all people have access to the quality health services they need without risk of impoverishment. But for universal health coverage to become reality, the health services offered must be consistent with the funds available--and this implies tough everyday choices for policymakers that could be the difference between life and death for those affected by any given condition or disease. The situation is particularly acute in low- and middle income countries where public spending on health is on the rise but still extremely low, and where demand for expanded services is growing rapidly.

What’s In, What’s Out: Designing Benefits for Universal Health Coverage argues that the creation of an explicit health benefits plan--a defined list of services that are and are not available--is an essential element in creating a sustainable system of universal health coverage. With contributions from leading health economists and policy experts, the book considers the many dimensions of governance, institutions, methods, political economy, and ethics that are needed to decide what’s in and what’s out in a way that is fair, evidence-based, and sustainable over time.

Amanda Glassman is the chief operating officer and a senior fellow at the Center for Global Development. Her research focuses on priority-setting, resource allocation and value for money in global health, and data for development.

Ursula Giedion has over 25 years of experience in health systems policy. Since 2010 she has served as a senior consultant for the Inter-American Development Bank in the area of health care financing and explicit priority setting.

Peter C. Smith is Emeritus Professor of Health Policy at Imperial College Business School. He previously served as Director of the Centre for Health Economics at the University of York.