Abstract
SummaryBackgroundDisease Control Priorities, 3rd edition (DCP3), published two model health benefits packages (HBPs). This study estimates the overall costs and individual component costs of these packages in low-income countries (LICs) and lower-middle-income countries (lower-MICs).MethodsThis study reports on our Disease Control Priorities Cost Model (DCP-CM), developed as part of the DCP3 project to determine the overall costs of the 218 health sector interventions recommended in the model HBP termed essential universal health coverage (EUHC). Model inputs included data on intervention unit costs, demographic and epidemiological data to quantify the populations in need of specific interventions, baseline coverage indicators, and estimates of required health system costs to support direct service delivery. The DCP-CM was informed primarily by published estimates of economic costs of interventions measured from the health system perspective. We estimated counterfactual annual costs for the year 2015. We disaggregated costs according to intervention characteristics (delivery platform, delivery timing, and health system objective) and did one-way and probabilistic sensitivity analyses with determination of 95% credible intervals (Crls).FindingsAt 80% population coverage, the annual cost of EUHC would be US$79 (95% Crl 60–110) per capita (in 2016 US dollars) in LICs and US$130 (100–180) per capita in lower-MICs. As a share of 2015 gross national income (GNI), additional investments would require 8·0% (95% Crl 5·7–11·3) in LICs and 4·2% (2·9–5·9) in lower-MICs. A highest priority subpackage comprising 115 of the EUHC interventions would cost approximately half of these amounts (3·7% [2·6–5·3] of 2015 GNI in LICs and 2·0% [1·4–2·8] in lower-MICs). Mortality-reducing interventions would require around two-thirds of the overall package costs, with interventions to reduce mortality at age 5–69 years from non-communicable disease and injury comprising the highest share of total EUHC costs in both income groups (37·6% [37·2–37·9] in LICs and 43·0% [42·6–43·4] in lower-MICs). Interventions addressing chronic health conditions (requiring 45·5% [44·8–46·4] 2015 GNI for LICs and lower-MICs combined) and interventions delivered in health centres (requiring 49·8% [49·5–50·2] 2015 GNI for LICs and lower-MICs combined) would each comprise the plurality of costs.InterpretationImplementation of EUHC would require costly investment, especially in LICs. DCP-CM is available as an online tool that can inform local HBP deliberation and support efficient investment in UHC, especially as countries pivot towards non-communicable disease and injury care.FundingBill & Melinda Gates Foundation, Trond Mohn Foundation, and Norwegian Agency for Development Cooperation.
Highlights
We estimate the potential cost of a model health benefits packages (HBPs), termed essential universal health coverage (UHC) (EUHC), that was developed in the latest edition of Disease Control Priorities (DCP3), and we explore the implications of the costs of essential universal health coverage (EUHC) for the health systems and UHC agendas in low-income countries (LICs) and lowerMICs
Study design As part of the DCP3 project, we developed a Disease Control Priorities Cost Model (DCP-CM) for the 218 health sector interventions recommended in the DCP3 model EUHC
We term our approach counterfactual because we looked at the cost implications of delivering all 218 EUHC interventions at 80% population coverage in 2015 compared with their actual coverage in 2015. 80% coverage was selected as a realistic and consistent target for interventions during the sustainable development goal (SDG) era
Summary
Health planners working in low-income countries (LICs) and middle-income countries (MICs) face difficult choices and trade-offs when selecting health interventions to include in publicly financed health-care systems. The constraints on the availability of public resources for health care in these countries limits access to necessary services and shifts costs to patients and their households, inevitably resulting in financial hardship. The global movement towards universal health coverage (UHC) has highlighted the importance of expanding health-care access, and of finance arrangements that can maximise prepayment and risk pooling and minimise financial risk. Most national UHC systems focus their spending on a list of high-priority health interventions, frequently referred to as a health benefits package (HBP), guaran teed to the population and, in principle, offered at little to no cost at the point of care.7Benefits packages have the potential to guide investm ent and strengthen health systems while directly addressing the health needs of populations and being mindful of budget constraints. The constraints on the availability of public resources for health care in these countries limits access to necessary services and shifts costs to patients and their households, inevitably resulting in financial hardship.. The global movement towards universal health coverage (UHC) has highlighted the importance of expanding health-care access, and of finance arrangements that can maximise prepayment and risk pooling and minimise financial risk.. Most national UHC systems focus their spending on a list of high-priority health interventions, frequently referred to as a health benefits package (HBP), guaran teed to the population and, in principle, offered at little to no cost at the point of care.. Benefits packages have the potential to guide investm ent and strengthen health systems while directly addressing the health needs of populations and being mindful of budget constraints. Previous literature has explored the process by which governments develop and implement HBPs; guidance is needed on the desired www.thelancet.com/lancetgh Vol 8 June 2020
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