A tisket, a tasket, is

MNCH in your

benefits basket?

March 2, 2015

Abt Associates | pg 2

Learning objectives

Define benefits packages

Recognize factors that influence the prioritization of

services offered by health systems

Recognize potential trade-offs that exist when

designing benefits packages

Identify criteria for designing

benefits packages that

support Ending Preventable and children

Child and Maternal Deaths

(EPCMD)

Abt Associates | pg 3

Session overview

Overview of health benefits “baskets” (benefits

package) design

Small group discussion of 2 country examples

Plenary discussion of implications for EPCMD

countries

Concluding remarks

Abt Associates | pg 4

What is a “benefits package”?

Benefits: set of health services covered through some

type of health financing arrangement (like insurance)

Package or basket:

– A limited subset of all health care interventions

– Determined through a prioritization process

• Explicit: List of covered services and financial

benefits for specific population groups, with

associated financing flows (sometimes linked to

“insurance”)

• Implicit: Services (and supplies/drugs) are available

to those who come to health care facilities until they

run out – first come, first served Source: Adapted from Wong and Bitran (1999)

Abt Associates | pg 5

Defining a “benefits package”

Defining a benefits package is a way to prioritize what services will be

offered, to whom, and at what price BEFORE resources are allocated.

– Allows for deliberate and scientific decision-making about spending a

country’s health funds

– Allows for increased transparency and accountability for what services are

offered

– “EXPLICIT PRIORITIZATION”

Otherwise, services are rationed across the population – by timing,

distance, social class, and chance

– Services (and supplies/drugs) available to those who come to health care

facilities until they run out – first come, first served

– “IMPLICIT RATIONING”

Abt Associates | pg 6

Why do benefits packages matter for

EPCMD?

They influence which services will be available

– Are the services cost-effective, given limited resources?

– Do they address the main causes of child and maternal deaths?

They influence which people will get services

– Are the services covered mainly needed by women and children, poor and

vulnerable groups, vs. services desired by the elite?

– Who is guaranteed coverage – full population or only certain groups?

They influence how much governments, and citizens, pay for

health care

– Can the government afford to provide the services in the benefits package?

– How much will people have to pay out-of-pocket for covered services?

They increase accountability for EPCMD

– Can be used to hold the government, providers, and insurance companies

accountable for service availability and quality

Abt Associates | pg 7

Technical considerations for EPCMD

benefits package design

1. Economic evaluations

• Cost-effectiveness analysis

• Financial protection analysis

2. Disease burden

• What are the main causes of ill

health and mortality?

3. Target population and equity

• Formal or informal sectors?

• Women? Men? Children? Elderly?

4. Service readiness and accessibility

• Is the capacity of health facilities and supply of staff and supplies sufficient?

5. Resource envelope Source: Adapted from USAID presentation by A.K. Nandakumar and Scott Stewart

Abt Associates | pg 8

Other considerations

Social preferences: What does the population say that it

wants to have covered?

“Rule of rescue”

Abt Associates | pg 9

Historical and Political Considerations

The status quo matters.

– Design process doesn’t start with a blank slate.

Role of political processes and stakeholder engagement

– Political institutions and culture

– Population’s awareness of rights and ability to make demands

– Strength of civil society, medical associations, and others

Who has real political power?

– Desire to target poor or achieve technically efficient outcomes may

hit barriers if system is dominated by wealthy constituents

Abt Associates | pg 10

Benefits Package Design Tradeoffs

To prioritize services covered, should a country …

Rely on cost-effectiveness analysis

vs. rely on social preferences?

Cover more population groups

vs. provide more kinds of services?

Satisfy immediate political goals

vs ensure sustainability?

Abt Associates | pg 11

Group Activity Instructions

Get into your groups and select a rapporteur

Read over the handout with country’s experience

covering MNCH services

Discuss questions on handout about trade-offs the

country made. Prepare to report to plenary group:

– What criteria/what trade-offs did your country prioritize when

designing its benefits package for MNCH?

– What is one pro and one con of this choice?

– Would you advise EPCMD countries to make the same trade-offs?

Why or why not?

Abt Associates | pg 12

Comparison of Benefit Packages for

MNCH Services

Chile

Who benefits?

– 97% of the population

What does it cover?

– A list of 80 prioritized conditions,

including some MNCH services

Who pays?

– Copays and premiums, linked to

ability to pay, with exemptions for

low income households

Argentina

Who benefits?

– Women and children in informal

sector

What does it cover?

– Comprehensive set of primary

care (treatment and preventive)

services for women and children,

including MNCH services

Who pays?

– Public tax funds

Abt Associates | pg 13

Key Takeaways

There are many approaches for covering MNCH services and

improving access and equity

Countries can’t cover all costs for all services for everyone right

away. They must prioritize.

Prioritizing technical criteria should help enhance the health and

poverty impacts of a benefits package, and support EPCMD

– Where is the bulk of the disease burden?

– What services are most cost-effective?

– What costs might be most impoverishing?

But prioritization process will always be shaped by historical

and political factors.

Prioritization requires making trade-offs!

Abt Associates | pg 14

Additional Resources

USAID-funded Health Finance and Governance Project:

www.hfgproject.org

Joint Learning Network for Universal Health Coverage:

jointlearningnetwork.org

Center for Global Development’s Priority-Setting Technical

Working Group: www.cgdev.org/working-group/priority-setting-

institutions-global-health

Inter-American Development Bank. 2014. Health Benefit Plans

in Latin America: A Regional Comparison